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Supplemental material
Supplement 1: Search Strategy (Ovid Medline)
Supplement 2: Table of included studies and references
Supplement 3: List of excluded studies of interest
Supplement 4: Meta-analyses of all health outcomes for change scores (Forest Plots)
Supplement 5: Meta-regression analyses for all health outcomes
Supplement 6: Meta-analyses of all health outcomes for end of study scores (Secondary analysis)
Supplement 1: Search strategy used in Medline (OVID interface)
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diet, protein-restricted/
diet, carbohydrate-restricted/
1 or 2
diet fads/
(carbohydrate* or protein*).ti,ab.
4 and 5
exp dietary proteins/
dietary carbohydrates/
(diet* or intake*).ti,ab.
(high* or increas* or rich or low* or restrict* or decreas* or reduc*).ti,ab.
(7 or 8) and 9 and 10
((carbohydrate* or protein*) adj3 (high* or increas* or rich or low* or restrict* or decreas* or reduc*)).ti,ab.
12 and 9
3 or 6 or 11 or 13
randomized controlled trial.pt.
controlled clinical trial.pt.
randomized.ab.
placebo.ab.
clinical trials as topic.sh.
randomly.ab.
trial.ti.
or/15-21
humans.sh.
22 and 23
14 and 24
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Supplement 2: List of included studies and details by primary study*
Primary study
(references)
Abete 2009
(1, 2)
No of
participants,
losses
19
Loss to followup and
dropouts: 0%
Characteristics of
patients
obese
BMI I:33.2; C:31.4
100% male
38 years
Location: SPAIN
Aldrich 2011
(3)
12
Loss to followup and
dropouts:
Obese
BMI 30
17% male
50 years
Location: USA
Appel 2005
(4-7)
Crossover trial
164
Loss to followup and
dropouts:
16%
hypertensive
BMI 30
55% male
54 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high protein (animal source) hypocaloric diet versus
control balanced diet energy restricted
Intervention diet:
hypocaloric, 2088 kcal/day, 30% pro, 33% cho, 37%
fat
Control diet:
hypocaloric, 1729 kcal/day, 19% pro, 51% cho, 33%
fat
Controlled moderate protein diet versus control diet
Intervention diet:
Hypocaloric, 1607 kcal/day, 31% pro, 41% cho, 13%
fat
Control diet:
Hypocaloric, 1601 kcal/day, 16% pro, 56% cho, 14%
fat
high protein (rich in plant protein) vs high
carbohydrate (similar to DASH diet); for weight
maintenance for 6 weeks
Intervention diet:
isocaloric, 2558 kcal/day, 25% pro, 50% vegetable
protein, 48% cho, 27% fat
Control diet:
isocaloric, 2599 kcal/day, 15% pro, 58% cho, 33%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
56
Weight, blood pressure, fglucose,
finsulin, satiety
56
Weight, blood pressure, total
cholesterol, HDL, LDL, TG, appetite,
bloating, dry mouth, hunger,
fullness
42
3
Primary study
(references)
Aude 2004
(8)
No of
participants,
losses
60
Loss to followup and
dropouts:
10%
Characteristics of
patients
obese
BMI I:35, C:36
52% male
I:46 years, C:44
years
Location: USA
Baba 1999
(9)
13
Loss to followup and
dropouts: 0%
obese
BMI I:37, C:35
100% male
Location:
LEBANON
BallesterosPomar 2009
(10)
36
Loss to followup and
dropouts: 0%
Overweight,
obese
BMI 32
33% male
Location:
Spain
Barnard 2004
(11,12)
64
Loss to followup and
dropouts: 8%
overweight ,
obese
BMI I:32.6;C:33.6
0% male
I:56 years;C:57
years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
3 phase diet with low carbohydrate (lower glycemic
index) increasing to wk 5-12 vs National Cholesterol
Education Program diet (normal protein), weight
loss both diets
Intervention diet:
hypocaloric, 1300-1600 kcal/day, 33% pro, 28%
cho, 39% fat
Control diet:
hypocaloric, 1300-1600 kcal/day, 15% pro, 55%
cho, 30% fat
high protein vs high carbohydrate, weight loss diets;
"natural foods"
Intervention diet:
hypocaloric, 45% pro, 25% cho, 30% fat
Control diet:
hypocaloric, 12% pro, 58% cho, 30% fat
Energy restricted high protein vs energy restricted
usual diet
Intervention diet:
Hypocaloric, 1840 kcal/day, 23% pro, 42% cho, 34%
fat
Control diet:
Hypocaloric, 1654 kcal/day, 18% pro, 55% cho, 27%
fat
ad libitum low fat diet (Step II National Cholesterol
Education Program) versus ad libitum very low-fat
vegan diet
Intervention diet:
ad libitum, 1424 kcal/day, 18% pro, 62%, 20% fat
Control diet:
ad libitum, 1408 kcal/day, 12% pro, 78% cho, 11%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, total cholesterol, HDL, LDL,
TG, Fglucose, Finsulin, satisfaction
84
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin,
satisfaction
28
Weight, BMI, waist circumference,
total cholesterol, HDL, LDL, TG,
fglucose, finsulin, C-reactive
protein
112
Weight, BMI, dietary restraint,
disinhibition, hunger
98
4
Primary study
(references)
Belobrajdic
2010
(13,14)
Bowden 2007
(15)
No of
participants,
losses
76 (from 112)
Loss to followup and
dropouts: 0%
108
Characteristics of
patients
obese
BMI 33
100% male
51 years
Location:
AUSTRALIA
obese and
healthy
34% male
20 years
Location: USA
108
obese and
healthy
34% male
20 years
Location: USA
Brehm 2003
(16)
53
Loss to followup and
dropouts:
21%
obese
BMI I:33.17;
C:34.04.
0% male
I:44 years; C:43
years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
High protein high red meat weight loss diet versus
high carbohydrate low red meat weight loss diet
Intervention diet:
hypocaloric, 1651 kcal/day, 33% pro, 37% cho, 30%
fat
Control diet:
hypocaloric, 1627 kcal/day, 21% pro, 51% cho, 28%
fat
high protein vs AHA recommended, weight
maintenance
Intervention diet:
isocaloric, 1222 kcal/day, 25% pro, 41% cho, 34%
fat
Control diet:
isocaloric, 1631 kcal/day, 16% pro, 51% cho, 33%
fat
high protein vs AHA recommended, weight loss
Intervention diet:
hypocaloric, 1487 kcal/day, 27% pro, 43% cho, 31%
fat
Control diet:
hypocaloric, 1465 kcal/day, 16% pro, 54% cho, 31%
fat
very low carbohydrate (high pro) ad libitum to low
fat (normal pro) with energy restriction
Intervention diet:
ad libitum (but consumed hypocaloric, ) 1156
kcal/day, 28% pro, 15% cho, 57% fat
Control diet:
hypocaloric, 1245 kcal/day, 18% pro, 54% cho, 28%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, fgluc,
84
Weight, Fglucose
84
Weight, Fglucose
84
Weight, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin
90
5
Primary study
(references)
No of
participants,
losses
53
Loss to followup and
dropouts:
21%
Characteristics of
patients
obese
BMI I:33.17;
C:34.04.
0% male
I:44 years; C:43
years
Location: USA
Brehm 2005
(17)
50
Loss to followup and
dropouts:
20%
obese
BMI I:32.8;
C:33.5.
0% male
I:45 years; C:41
years
Location: USA
Brinkworth
2009
(18-23)
117
Loss to followup and
dropouts: 7%
obese
BMI 34
36% male
I:51 years, C:49
years
Location:
AUSTRALIA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
very low carbohydrate (high pro) ad libitum to low
fat (normal pro) with energy restriction
Intervention diet:
ad libitum (but consumed hypocaloric) 1302
kcal/day, 23% pro, 30% cho, 46% fat
Control diet:
hypocaloric, 1247 kcal/day, 18% pro, 29% cho, 53%
fat
very low carbohydrate (high pro) no energy
restriction to low fat (normal pro) with energy
restriction
Intervention diet:
ad libitum but consumed same amount of energy as
control group 1288 kcal/day, 28% pro, 15% cho,
57% fat
Control diet:
hypocaloric, 1339 kcal/day, 18% pro, 53% cho, 29%
fat
very low carbohydrate, high saturated fat diet vs
conventional high carbohydrate, low saturated fat
diet, both weight loss
Intervention diet:
hypocaloric, 1578 kcal/day, 35% pro, 5% cho, 59%
fat
Control diet:
hypocaloric, 1574 kcal/day, 24% pro, 47% cho, 28%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin
180
Weight, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose
60
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein, mood
56
6
Primary study
(references)
No of
participants,
losses
118
Loss to followup and
dropouts:
26%
Characteristics of
patients
obese
BMI 34
I:51 years, C:49
years
Location:
AUSTRALIA
118
Loss to followup and
dropouts:
41%
obese
BMI 34
Buscemi 2009
(24)
25
Loss to followup and
dropouts:
20%
Dansinger
2005
(25)
80
Loss to followup and
dropouts:
35%
overweight ,
obese
BMI I:34.5; C:34
0% male
I:38 years;C:39
years
Location: ITALY
obese , at least 1
cardiac risk factor
BMI I:34, C:35
54% male
I:51 years, C:49
years
Location: USA
I:51 years, C:49
years
Location:
AUSTRALIA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
very low carbohydrate, high saturated fat diet vs
conventional high carbohydrate, low saturated fat
diet, both weight loss
Intervention diet:
hypocaloric, 1605 kcal/day, 33% pro, 8% cho, 56%
fat
Control diet:
hypocaloric, 1520 kcal/day, 23% pro, 45% cho, 27%
fat
very low carbohydrate, high saturated fat diet vs
conventional high carbohydrate, low saturated fat
diet, both weight loss
Intervention diet:
hypocaloric, 1644 kcal/day, 32% pro, 9% cho, 55%
fat
Control diet:
hypocaloric, 1624 kcal/day, 22% pro, 46% cho, 26%
fat
atkins diet (very low carbohydrate) low calories
versus mediterranean diet low calorie diet
Intervention diet:
hypocaloric, kcal/day, 25% pro, 20% cho, 55% fat
Control diet:
hypocaloric, kcal/day, 20% pro, 55% cho, 25% fat
zone diet (high protein) vs. Weight Watchers' diet
based on points (lower protein), diets for weight loss
and cardiac effects
Intervention diet:
ad libitum (but was hypocaloric, ) 1434 kcal/day,
25% pro, 40% cho, 35% fat
Control diet:
hypocaloric, 1615 kcal/day, 20% pro, 47% cho, 31%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein, mood
168
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein, serum
creatinine, mood
365
Weight, waist circumference, blood
pressure, total cholesterol, HDL,
LDL, TG, Fglucose, Finsulin
60
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein,
adverse events
60
7
Primary study
(references)
Das 2007
(26)
No of
participants,
losses
34
Loss to followup and
dropouts: 15%
Characteristics of
patients
overweight
BMI 28
24% male
35 years
Location: USA
De Luis 2007
(27)
90
Loss to followup and
dropouts: 0%
obese
BMI 35.8
30% male
43 years
Location: Spain
De Luis 2009a
(28)
193
Loss to followup and
dropouts: 0%
obese
BMI 34.7
25% male
46 years
Location: SPAIN
De Luis 2009b
(29)
118
Loss to followup and
dropouts: 0%
obese
BMI 35.4
28% male
46 years
Location: SPAIN
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
Energy restricted low glycemic load high protein diet
vs energy restricted high glycemic load lower protein
diet
Intervention diet:
Hypocaloric, 1900 kcal/day, 30% pro, 40% cho, 30%
fat
Control diet:
Hypocaloric, 1960 kcal/day, 20% pro, 60% cho, 20%
fat
low fat (low protein) versus low carbohydrate diet
(high protein) both for weight loss
Intervention diet:
hypocaloric, 1574 kcal/day, 26% pro, 31% cho, 43%
fat
Control diet:
hypocaloric, 1630 kcal/day, 20% pro, 55% cho, 25%
fat
low carbohydrate diet (with higher protein)
hypocaloric diet versus low fat diet (with higher
protein) hypocaloric diet
Intervention diet:
hypocaloric, 1578 kcal/day, 26% pro, 31% cho, 36%
fat
Control diet:
hypocaloric, 1628 kcal/day, 20% pro, 53% cho, 25%
fat
low carbohydrate diet (with higher protein)
hypocaloric diet versus low fat diet (with higher
protein) hypocaloric diet
Intervention diet:
hypocaloric, 1548 kcal/day, 26% pro, 31% cho, 36%
fat
Control diet:
hypocaloric, 1613 kcal/day, 20% pro, 52% cho, 25%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, total cholesterol, HDL, LDL,
TG, Fglucose, Finsulin, hunger and
satisfaction
365
Weight, BMI, Waist circumference,
C-reactive protein
90
Weight, BMI, Waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
60
Weight, BMI, Waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
90
8
Primary study
(references)
Delbridge
2009
(30)
Due 2004
(31-35)
No of
participants,
losses
139
Loss to followup and
dropouts: 42%
50
Loss to followup and
dropouts: 8%
50
Loss to followup and
dropouts:
36%
Dyson 2007
(36)
13
Loss to followup and
dropouts:
23%
Characteristics of
patients
Overweight,
obese
BMI 39
50% male
44 years
Location:
Australia
overweight ,
obese
BMI I:30;C:31
24% male
I:40 years; C:39
years
Location:
Denmark
overweight ,
obese
BMI I:30;C:31
24% male
I:40 years; C:39
years
Location:
Denmark
obese
BMI 36
23% male
51 years
Location: UK
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
High protein vs high carbohydrate diet
Intervention diet:
Isocaloric, 1589 kcal/day, 28% pro, 38% cho, 34% fat
Control diet:
Isocaloric, 1678 kcal/day, 22% pro, 47% cho, 30% fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG
365
High carbohydrate to high protein, both ad libitum
Intervention diet:
ad libitum 2150 kcal/day, 24% pro, 46% cho, 30% fat
Control diet:
ad libitum 2580 kcal/day, 12% pro, 59% cho, 29% fat
Weight, BMI, Waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin,
CRP, appetite, discomfort, Bone
mineral density
180
high protein and high carbohydrate diet ad libitum diet counseling only
Intervention diet:
ad libitum 2006 kcal/day, 21% pro, 49% cho, 30% fat
Control diet:
ad libitum 1959 kcal/day, 14% pro, 55% cho, 31% fat
Weight, BMI, Waist circumference,
total cholesterol, HDL, LDL, TG,
Fglucose, Finsulin
365
carbohydrate diet to <=40 g per day with lean
protein sources vs healthy energy restiricted diet by
Diabetes UK - in diabetes and nondiabetes nondiabetes data only used
Intervention diet:
ad libitum but was hypocaloric, 1289 kcal/day, 30%
pro, 22% cho, 22% fat
Control diet:
hypocaloric, 1526 kcal/day, 19% pro, 44% cho, 35%
fat
Weight, BMI, HbA1C, total
cholesterol, HDL, LDL, TG
90
9
Primary study
(references)
Farnsworth
2003
(37-39)
No of
participants,
losses
66
Loss to followup and
dropouts:
16%
Characteristics of
patients
obese
BMI I: 34(M),
35(F), C:35(M),
34(F)
25% male
I: 52(M), 51(F),
C:49(M), 51(F)
years
Location:
AUSTRALIA
healthy
BMI I:23, C:24
100% male
26 years
Location: ITALY
Ferrara 2006
(40)
15
Loss to followup and
dropouts: 0%
Fleming
2002
(41)
56
Loss to followup and
dropouts: 0%
overweight ,
obese
weight I:232
lbs;C:226 lbs
47% male
43 years
Location: USA
Foster 2003
(42)
63
Loss to followup and
dropouts:
23%, 33%,
41%
obese
BMI 34
32% male
44 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high protein versus standard protein, both energy
restricted diets, 12 week weight loss then 4 wk
weight maintenance
Intervention diet:
hypocaloric, 1505 kcal/day, 27% pro, 10% vegetable
protein, 44% cho, 27% fat
Control diet:
hypocaloric, 1552 kcal/day, 16% pro, 57% cho, 27%
fat
high protein vs normal protein, weight maintenance
Intervention diet:
isocaloric, 2525 kcal/day, 19.5% pro, 54% cho, 26%
fat
Control diet:
isocaloric, 2300 kcal/day, 15% pro, 59% cho, 26%
fat
4 diets compared. High fat ad libitum (also high
protein) compared to phase II (moderate fat diet,
calorie restricted, norm protein) chosen
Intervention diet:
ad libitum but was hypocaloric, kcal/day, high
protein
Control diet:
hypocaloric, 1550 kcal/day, 15% pro, 70% cho, 15%
fat
atkins diet vs conventional diet
Intervention diet:
ad libitum, high protein
Control diet:
hypocaloric, lower protein
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
28, 56,
84
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG,
creatinine
180
Weight, total cholesterol, HDL, LDL,
TG
365
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG
90,
180,
365
10
Primary study
(references)
Gardner 2007
(43)
Greene 2004
(44)
Hodgson
2006
(45, 46)
No of
participants,
losses
156
Characteristics of
patients
obese
BMI I:32, C:31
0% male
I:42 years, C:40
years
Location: USA
10
Loss to followup and
dropouts: 0%
overweight
BMI 33
33% male
58 years
Location: USA
11
Loss to followup and
dropouts: 0%
overweight
BMI 33
33% male
58 years
Location: USA
71
Loss to followup and
dropouts:
15%
hypertensive
BMI 28
63% male
C:60 years, I:57
years
Location:
AUSTRALIA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
atkins low carbohydrate (higher protein) vs LEARN
('prudent' diet. High carbohydrate, low fat, caloric
restriction)
Intervention diet:
ad libitum (but was hypocaloric, ) 1381 kcal/day,
28% pro, 18% cho, 55% fat
Control diet:
hypocaloric, 1476 kcal/day, 20% pro, 49% cho, 30%
fat
low fat (low protein) versus ketogenic low
carbohydrate diet 1 (high protein) both for weight
loss
Intervention diet:
hypocaloric, 1500/1800 kcal/day, 30% pro, 5% cho,
65% fat
Control diet:
hypocaloric, 1500/1800 kcal/day, 15% pro, 55%
cho, 30% fat
low fat (low protein) versus ketogenic low
carbohydrate diet 1 (high protein) both for weight
loss
Intervention diet:
hypocaloric, 1500/1800 kcal/day, 30% pro, 5% cho,
65% fat
Control diet:
hypocaloric, 1500/1800 kcal/day, 15% pro, 55%
cho, 30% fat
substitution of carbohydrate with lean red meat vs.
Usual diet
Intervention diet:
isocaloric, 2221 kcal/day, 24% pro, 39% cho, 31%
fat
Control diet:
isocaloric, 2006 kcal/day, 19% pro, 43% cho, 32%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG
60
Weight, waist circumference, total
cholesterol, HDL, LDL, TG,
creatinine
84
Weight, waist circumference, total
cholesterol, HDL, LDL, TG,
creatinine
84
Weight, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, HbA1C, C-reactive protein
56
11
Primary study
(references)
Iglay 2007
(47)
No of
participants,
losses
50
Loss to followup and
dropouts:
28%
Characteristics of
patients
healthy
BMI I:27, C:26
47% male
I:61, C:62
Location: USA
Jenkins 2001
(48,49)
Crossover trial
20
Loss to followup and
dropouts: 0%
Hyperlipidemic,
obese
BMI 26
75% male
56 years
Location: Canada
Jenkins 2009
(50)
50
Loss to followup and
dropouts:
16%
overweight,
hyperlipidemic
BMI 31
44% male
57 years
Location: Canada
Johnston
2004
(51)
20
Loss to followup and
dropouts:
20%
overweight
BMI 29
10% male
I:40 years; C: 36
years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high to low prot, no weight loss, increase in animal
proteins
Intervention diet:
isocaloric, 2099 kcal/day, 17% pro, 34% vegetable
protein, 50% cho, 33% fat
Control diet:
isocaloric, 2079 kcal/day, 12% pro, 53% cho, 34%
fat
high vegetable protein (gluten) diet to normal diet both weight maintenance
Intervention diet:
isocaloric, 2764 kcal/day, 27% pro, 74% vegetable,
47% cho, 26% fat
Control diet:
isocaloric, 2835 kcal/day, 16% pro, 46% vegetable,
59% cho, 26% fat
plant-based low carbohydrate (eco-atkins) vs high
carbohydrate lacto-ovo vegetarian diet
Intervention diet:
hypocaloric, 1451 kcal/day, 30% pro, 27% cho, 43%
fat
Control diet:
Hypocaloric, 1488 kcal/day, 17% pro, 58% cho, 25%
fat
energy and fat restricted diets: high protein vs high
carbohydrate
Intervention diet:
hypocaloric, 1700 kcal/day, 32% pro, 40% cho, 28%
fat
Control diet:
hypocaloric, 1700 kcal/day, 15% pro, 66% cho, 21%
fat
Outcomes meeting inclusion criteria
Followup(days)
BMI, waist circumference, total
cholesterol, HDL, LDL, TG, HbA1C
98, 84
Blood pressure, total cholesterol,
HDL, LDL, TG, creatinine,
30
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, HbA1c, C-reactive protein,
satiety
28
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, satiety
42
12
Primary study
(references)
Josse 2011
(52, 53)
Keogh 2007
(54)
Kleiner 2006
(55)
No of
participants,
losses
90
Loss to followup and
dropouts: 10%
Characteristics of
patients
Overweight,
obese
BMI 32
0% male
28 years
Location: Canada
44
Loss to followup and
dropouts:
43%
obese
BMI 33
32% male
49 years
Location:
AUSTRALIA
44
Loss to followup and
dropouts:
70%
obese
BMI 33
32% male
49 years
Location:
AUSTRALIA
20
Loss to followup and
dropouts:
20%
obese
I:34.6;C:35.9
25% male
35 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
High protein, high dairy hypoenergetic diet vs
adequate protein, medium dairy hypoenergetic diet
Intervention diet:
Hypocaloric, 1500 kcal/day, 28% pro, 41% cho, 31%
fat
Control diet:
Hypocaloric, 1430 kcal/day, 18% pro, 58% cho, 24%
fat
high carbohydrate vs low carbohydrate diet, weight
loss
Intervention diet:
hypocaloric, 1496 kcal/day, 36% pro, 38% cho, 25%
fat
Control diet:
hypocaloric, 1491 kcal/day, 23% pro, 53% cho, 21%
fat
high carbohydrate vs low carbohydrate diet, weight
loss
Intervention diet:
hypocaloric, 1496 kcal/day, 36% pro, 38% cho, 25%
fat
Control diet:
hypocaloric, 1491 kcal/day, 23% pro, 53% cho, 21%
fat
high protein low fat diet vs. High carbohydrate low
fat diet - weight loss =70 to 75% of energy needs
Intervention diet:
hypocaloric, 32% pro, 41% cho, 27% fat
Control diet:
hypocaloric, 14% pro, 59% cho, 27% fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin, Creactive protein, BMD
112
Weight, Waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
42, 84
Weight, Waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
365
Weight, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin
56
13
Primary study
(references)
Labayen 2003
(56)
Landers 2002
(57)
Lasker 2008
(58)
Layman 2005
(59)
No of
participants,
losses
11
Loss to followup and
dropouts: 0%
Characteristics of
patients
obese
BMI I:39, C:37
100% male
23-57 years
Location: SPAIN
63
Loss to followup and
dropouts:
63%
65
obese
BMI>27
unlcear
18 to 55 years
Location: USA
overweight ,
obese
BMI 33.6
38% male
47 years
Location: USA
24
Loss to followup and
dropouts: 0%
overweight
BMI 32.9
0% male
47 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high carbohydrate to high protein (low
carbohydrate), energy restricted diets
Intervention diet:
hypocaloric, 30% pro, 40% cho, 30% fat
Control diet:
hypocaloric, 15% pro, 55% cho, 30% fat
Zone diet (high protein) vs. Conventional weight loss
Intervention diet:
ad libitum, 30% pro, 40% cho, 30% fat
Control diet:
hypocaloric, 20% pro, 50% cho, 30% fat
high protein, low carbohydrate energy restricted diet
versus high carbohydrate, low protein, low fat
energy restricted diet
Intervention diet:
hypocaloric, 1578 kcal/day, 30% pro, 39% cho, 32%
fat
Control diet:
hypocaloric, 1403 kcal/day, 5% pro, 61% cho, 25%
fat
low carbohydrate (high protein) weight loss diet vs
high carbohydrate (low protein) weight loss diet
Intervention diet:
hypocaloric, 1448 kcal/day, 30% protein, 39% cho,
32% fat
Control diet:
hypocaloric, 1284 kcal/day, 18% protein, 61% cho,
24% fat
Outcomes meeting inclusion criteria
Followup(days)
Weight
70
Weight
84
Weight, BMI, Fglucose
120
Weight, total cholesterol, HDL, LDL,
TG, Finsulin
112
14
Primary study
(references)
No of
participants,
losses
24
Loss to followup and
dropouts: 0%
Characteristics of
patients
overweight
BMI 32.9
0% male
47 years
Location: USA
Layman 2009
(60)
130
Loss to followup and
dropouts:
21%
overweight ,
obese
BMI 32.6
45% male
45 years
Location: USA
Lean 1997
(61)
110
obese
BMI I:33, C:32
0% male
I:50 years, C:51
years
Location: UK
Leidy 2007
(62, 64)
54
Loss to followup and
dropouts:
15%
overweight ,
obese
BMI 31
0% male
I:46 years;C:53
years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
low carbohydrate (high protein) weight loss diet vs
high carbohydrate (low protein) weight loss diet
Intervention diet:
hypocaloric, 1323 kcal/day, 31% protein, 38% cho,
31% fat
Control diet:
hypocaloric, 1348 kcal/day, 17% pro, 60% cho, 24%
fat
high protein, low carbohydrate energy restricted diet
versus high carbohydrate, low protein, low fat
energy restricted diet
Intervention diet:
hypocaloric, 1607 kcal/day, 29% pro, 38% cho, 32%
fat
Control diet:
hypocaloric, 1481 kcal/day, 18% pro, 59% cho, 26%
fat
low carbohydrate (high protein) vs high
carbohydrate (low protein), weight loss
Intervention diet:
hypocaloric, 1197 kcal/day, 30% pro, 35% cho, 35%
fat
Control diet:
hypocaloric, 1198 kcal/day, 21% pro, 58% cho, 21%
fat
high protein to normal protein, weight loss 750 kcal
deficit
Intervention diet:
hypocaloric, 1540 kcal/day, 30% pro, 45% cho, 25%
fat
Control diet:
hypocaloric, 1500 kcal/day, 18% pro, 57% cho, 22%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, total cholesterol, HDL, LDL,
TG, Finsulin
112
Weight, HDL, LDL, TG
120
Weight, BMI, waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG
(30
weight
only),
90, 120
(weight
only),
180
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG, Fglucose,
creatinine, appetite, arousal-sleep,
pleasure, hunger, desire to eat,
fullness, BMD
84, (63
hunger,
desire
to eat,
fullness
)
15
Primary study
(references)
Lopez-Jiminez
2010
(65)
LuscombeMarsh 2005
(66, 67)
No of
participants,
losses
55
Loss to followup and
dropouts: 0%
73
Loss to followup and
dropouts:
22%
Characteristics of
patients
Metabolic
syndrome
BMI 34.5
obese
BMI 34
36% male
50 years
Location:
AUSTRALIA
Mahon 2007
(68, 69)
61
Loss to followup and
dropouts:
11%
obese
hyperlipidemic
C:28.4; I:30.1
0% male
between 50 and
80 yrs
Location: USA
Maki 2007
(70)
86
Loss to followup and
dropouts:
19%
overweight ,
obese
BMI 32
33% male
50 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
Low carbohydrate, relatively high protein enriched
with mono- or polyunsaturated oils vs standard diet
for diabetic patients
Low fat high protein vs high fat standard protein,
both weight loss for 12 wks, then 4 wks maintenance
Intervention diet:
hypocaloric, 1472 kcal/day, 34% pro, 35% cho, 29%
fat
Control diet:
hypocaloric, 1426 kcal/day, 18% pro, 35% cho, 45%
fat
weight loss diets: beef moderate protein vs.
Lactoovo vegetarian lower protein
Intervention diet:
hypocaloric, 1114 kcal/day, 24% pro, 100%
vegetable protein, 46% cho, 30% fat
Control diet:
hypocaloric, 1158 kcal/day, 17% pro, 59% cho, 24%
fat
low carbohydrate, low glycemic ad libitum diet
compared to nutritionally balanced lower fat diet
energy restricted
Intervention diet:
ad libitum 1343 kcal/day, 26% protein, 32% cho,
42% fat
Control diet:
hypocaloric, 1500 kcal/day, 19% pro, 46% cho, 37%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, waist circumference,
total cholesterol, HDL, LDL, TG,
Fglucose, Finsultin, C reactive
protein
Weight, total cholesterol, HDL, LDL,
TG, adverse events
180
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin, Creactive protein, BMD
63
Weight, waist circumference, blood
pressure, total cholesterol, HDL,
LDL, TG, Fglucose, Finsulin
84
28
(weight
only) and
56
(weight,
Fglucose,
Finsulin),
84
16
Primary study
(references)
Mamo 2005
(71)
No of
participants,
losses
20
Loss to followup and
dropouts: 0%
McAuley 2005
(72)
62
Loss to followup and
dropouts: 8%
McMillanPrice 2006
(73)
129
Loss to followup and
dropouts: 9%
Characteristics of
patients
hyperlipidemic
BMI 32
60% male
I:55 years, C:41
years
Location:
AUSTRALIA
obese
BMI I:35, C:37
0% male
I:47 years, C:45
years
Location: New
Zealand
obese
BMI - high
glycemic groups:
31; low glycemic
groups I:32, C:31
24% male
high glycemic
groups I:31, C:32
years; low
glycemic groups
I:35, C:30 years
Location:
AUSTRALIA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high protein vs low protein, weight maintenance
Intervention diet:
isocaloric, 24% pro, 43% cho, 30% fat
Control diet:
isocaloric, 17% pro, 52% cho, 27% fat
zone (high protein) vs. Healthy eating, non diabetci
(high carbohydrate, high fibre) diets. For 8 weeks
weight loss + 16 weeks maintenance
Intervention diet:
ad libitum (but was hypocaloric, ) 1353 kcal/day,
28% pro, 34% cho, 35% fat
Control diet:
ad libitum (but was hypocaloric, ) 1372 kcal/day,
21% pro, 49% cho, 24% fat
high carbohydrate to high protein (with high GI),
reduced fat, weight loss
Intervention diet:
hypocaloric, 1400-1900 kcal/day, 28% pro, 42%
cho, 27% fat
Control diet:
hypocaloric, 1400-1900 kcal/day, 18% pro, 60%
cho, 19% fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, total cholesterol,
HDL, LDL, TG, Finsulin
42
Weight, BMI, waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin, Creactive protein
56
Weight, waist circumference, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein
84
17
Primary study
(references)
No of
participants,
losses
129
Loss to followup and
dropouts:
11%
Meckling
2004
(74)
40
Loss to followup and
dropouts:
23%
Meckling
2007
(75)
60
Loss to followup and
dropouts:
40%
Characteristics of
patients
obese
BMI - high
glycemic groups:
31; low glycemic
groups I:32, C:31
24% male
high glycemic
groups I:31, C:32
years; low
glycemic groups
I:35, C:30 years
Location:
AUSTRALIA
overweight
BMI 32
71% male
I:41 years; C:43
years
Location: Canada
obese
BMI I: 31, C:29
0% male
I:45 years, C:47
years, I(with
exercise):37
years, C(with
intervention):41
years
Location:
CANADA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high carbohydrate to high protein (with low GI),
reduced fat, weight loss
Intervention diet:
hypocaloric, 1400-1900 kcal/day, 26% pro, 40%
cho, 29% fat
Control diet:
hypocaloric, 1400-1900 kcal/day, 19% pro, 56%
cho, 22% fat
low carbohydrate (high protein) versus low fat
(lower protein) both weight loss
Intervention diet:
hypocaloric, 1534 kcal/day, 26% pro, 15% cho, 56%
fat
Control diet:
hypocaloric, 1451 kcal/day, 20% pro, 62% cho, 18%
fat
control to high protein, weight loss
Intervention diet:
hypocaloric, 1383 kcal/day, 24% pro, 37% cho, 39%
fat
Control diet:
hypocaloric, 1391 kcal/day, 16% pro, 50% cho, 34%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, waist circumference, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein
84
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin,
adverse effects
70
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin, Creactive protein
84
18
Primary study
(references)
Moran 2003
(76, 77)
No of
participants,
losses
60
Loss to followup and
dropouts:
17%
45
Loss to followup and
dropouts: 0%
45
Loss to followup and
dropouts:
37%
Characteristics of
patients
obese
BMI I: 31, C:29
0% male
I:45 years, C:47
years, I(with
exercise):37
years, C(with
intervention):41
years
Location:
CANADA
Obese, polycystic
ovary syndrome
BMI 38
0% male
33 years
Location:
AUSTRALIA
obese, polycystic
ovary syndrome
BMI 38
0% male
33 years
Location:
AUSTRALIA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high protein with exercise vs low protein with
exercise, weight loss
Intervention diet:
hypocaloric, 1217 kcal/day, 37% pro, 36% cho, 26%
fat
Control diet:
hypocaloric, 1260 kcal/day, 18% pro, 50% cho, 29%
fat
high protein vs low protein for weight loss, 12 week
weight loss, 4 week maintenance
Intervention diet:
hypocaloric, 1494 kcal/day, 27% pro, 43% cho, 28%
fat
Control diet:
hypocaloric, 1514 kcal/day, 16% pro, 57% cho, 27%
fat
high protein vs low protein for weight loss, 12 week
weight loss, 4 week maintenance, entered as 12
weeks
Intervention diet:
hypocaloric, 1494 kcal/day, 27% pro, 43% cho, 28%
fat
Control diet:
hypocaloric, 1514 kcal/day, 16% pro, 57% cho, 27%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, waist circumference, total
cholesterol, HDL, LDL, TG, Fglucose,
Finsulin, C-reactive protein
84
Weight
112
BMI, total cholesterol, HDL, LDL,
TG, Fglucose, Finsulin, depression
84
19
Primary study
(references)
Morgan 2008
(78, 79)
No of
participants,
losses
118
Loss to followup and
dropouts: 28%
Characteristics of
patients
Overweight and
obese
BMI 31
30% male
40 years
Location: United
Kingdom
obese
BMI 37
27% male
C:52 years, I:53
years
Location: ITALY
Muzio 2007
(80)
100
Loss to followup and
dropouts: 0%
NickolsRichardson
2005
(81)
28
Loss to followup and
dropouts: 0%
overweight
BMI I:31.1, C:30.3
100%
I:39 years; C:40
years
Location: USA
Noakes 2005
(82)
119
Loss to followup and
dropouts:
16%
obese
BMI I:32, C:33
0% male
I:50 years, C:49
years
Location:
AUSTRALIA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
Atkins diet (low carbohydrate) vs usual diet
Intervention diet:
1630 kcal/day, 26% pro, 18% cho, 56% fat
Control diet:
Isocaloric, 1596 kcal/day, 20% pro, 39% cho, 40% fat
high carbohydrate to low carbohydrate-high proteinhigh monounsaturated fat for weight loss
Intervention diet:
hypocaloric, 1490 kcal/day, 19% pro, 25% vegetable
protein, 48% cho, 33% fat
Control diet:
hypocaloric, 1456 kcal/day, 13% pro, 60%
vegetable, 65% cho, 22% fat
low carbohydrate/high protein diet (Atkins diet with
changing carbohydrate over time) ad libitum vs high
carbohydrate/low fat diet energy restricted
Intervention diet:
ad libitum (but consumed hypocaloric, ) 1420
kcal/day, 26% pro, 12% cho, 61% fat
Control diet:
hypocaloric, 1395 kcal/day, 18% pro, 60% cho, 22%
fat
high protein, low saturated fat vs high carbohydrate,
low saturated fat, both weight loss, 12 weeks
Intervention diet:
hypocaloric, 1268 kcal/day, 31% pro, 44% cho, 22%
fat
Control diet:
hypocaloric, 1247 kcal/day, 18% pro, 61% cho, 20%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, waist circumference, blood
pressure, total cholesterol, HDL,
LDL, TG, Fglucose
180
Weight, BMI, waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin
150
Weight, BMI, cognitive eating,
hunger
42
Weight, total cholesterol, HDL, LDL,
TG, Fglucose, Finsulin, C-reactive
protein
84
20
Primary study
(references)
Noakes 2006
(83)
No of
participants,
losses
55
Loss to followup and
dropouts:
0.19%
Characteristics of
patients
obese
BMI 33
16% male
I: 48 years, C: 46
years
Location:
AUSTRALIA
Phillips 2008
(84)
28
Loss to followup and
dropouts:
29%
obese
BMI 34
25 % male
I:33 years, C:38
years
Location: USA
Rouse 1986
(85-87)
Crossover trial
40
Loss to followup and
dropouts: 3%
Sacks 1984
(88)
Crossover trial
23
Loss to followup and
dropouts:
22%
healthy
weight I:70kg;C:67kg
49% male
I:40 years;C:41
years
Location: USA
vegans
weight 63 kg
39% male
32 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
very low carbohydrate diet (high protein) vs low sat
fat/high unsaturated fat diet - both energy restricted
Intervention diet:
hypocaloric, 1479 kcal/day, 33% pro, 9% cho, 55%
fat
Control diet:
hypocaloric, 1432 kcal/day, 23% pro, 48% cho, 27%
fat
low carbohydrate (high protein according to Atkins'
diet) vs low fat (American Heart Association) 750
kcal decrease; diets were 6 weeks (4 week weight
loss, 2 maintenance)
Intervention diet:
ad libitum (but was hypocaloric, ) 1855 kcal/day,
32% pro, 5% cho, 22% fat
Control diet:
hypocaloric, 1755 kcal/day, 21% pro, 58% cho,
23%fat
omnivore diet weight maintenance versus lacto-ovovegetarian diet weight maintenance
Intervention diet:
ad libitum 2193 kcal/day, 16% pro, 41% cho, 40% fat
Control diet:
ad libitum 2174 kcal/day, 12% pro, 27% cho, 39% fat
high protein vs low protein foods added to vegan
diets of below average protein
Intervention diet:
isocaloric, 1879 kcal/day, 25% pro, 56% cho, 19%
fat
Control diet:
isocaloric, 1589 kcal/day, 16% pro, 60% cho, 24%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, total cholesterol, HDL, LDL,
TG, Fglucose, Finsulin
56
Fglucose, Finsulin
28
Weight, blood pressure
56
Weight, blood pressure
56
21
Primary study
(references)
Sacks 2009
(89)
No of
participants,
losses
405
Loss to followup and
dropouts: 17%
Schweiger
1986
(90)
18
Loss to followup and
dropouts: 0%
Seshadri 2004
(91, 92)
132
randomised
(45 nondiabetic)
Stamets 2004
(93)
35
Loss to followup and
dropouts:
26%
Stoernell
2008
(94)
28
Loss to followup and
dropouts:
18%
Characteristics of
patients
Overweight,
obese
BMI 33
37% male
51 years
Location: USA
healthy
BMI I:22.6; C:21.9
0% male
I:24 years; C:22
years
Location:
Germany
severe obesity
I:44;C:42
69% male
I:53 years;C:52
years
Location: USA
Obese, polycystic
ovary syndrome
BMI I:38, C:37
0% male
I:29 years, C:26
years
Location: USA
hypertriglyceremi
a, diabetes
BMI I:34.5;C:29.6
48% male
I:57 years; C: 48
years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
Low fat, average protein to high fat, high protein diet
Intervention diet:
hypocaloric, 1624 kcal/day, 23% pro, 43% cho, 34%
fat
Control diet:
hypocaloric, 1636 kcal/day, 18% pro, 58% cho, 26%
fat
mixed protein (higher protein) to vegetarian diet
Intervention diet:
hypocaloric, 923 kcal/day, 20% pro, 48% cho, 30%
fat
Control diet:
hypocaloric, 1142 kcal/day, 12% pro, 62% cho,
23%fat
low carbohydrate, no restriction to fat intake
Intervention diet:
ad libitum 1343 kcal/day, 25% pro, 31% cho, 44% fat
Control diet:
hypocaloric, 1590 kcal/day, 16% pro, 51% cho, 32%
fat
high protein vs high carbohydrate (normal protein),
diets were 1000kcal below needs. Fat similar
Intervention diet:
hypocaloric, 30% pro, 40% cho, 30% fat
Control diet:
hypocaloric, 15% pro, 55% cho, 30% fat
Atkins (low carbohydrate not energy restricted) vs.
Low fat (energy restricted)
Intervention diet:
hypocaloric, 25% pro, 20% cho, 55% fat
Control diet:
hypocaloric, 20% pro, 48% cho, 33% fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, waist circumference,
satiety, quality of life, adverse
events
180
Weight, global mood
42
TG, HbA1C, Fglucose, Finsulin
180
Weight, waist circumference, blood
pressure, total cholesterol, HDL,
LDL, TG,
28
Weight, waist circumference, total
cholesterol, HDL, LDL, TG, Creactive protein, satiety
56
22
Primary study
(references)
Te Morenga
2011
(95)
No of
participants,
losses
83
Loss to followup and
dropouts: 11%
Characteristics of
patients
Overweight,
obese
BMI 34
0% male
42 years
Location: New
Zealand
Thorpe 2008
(96)
71
Loss to followup and
dropouts:
20%
obese
BMI I: 31, C: 32
0% male
I: 45 years, C: 46
years
Location: USA
Volek 2003
(97)
Crossover trial
10
Loss to followup and
dropouts: 0%
healthy
BMI 22
0% male
26 years
Location: USA
Volek 2004
(98-101)
Crossover trial
15
Loss to followup and
dropouts: 0%
overweight ,
obese
BMI 34
100% male
33 years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
Moderately high protein energy restricted diet vs
high fibre relatively high carbohydrate energy
restricted diet
Intervention diet:
Hypocaloric, 1556 kcal/day, 28% pro, 40% cho, 32%
fat
Control diet:
Hypocaloric, 1428 kcal/day, 22% pro, 51% cho, 27%
fat
4 months of weight loss diet then 8 months of
weight maintenance
Intervention diet:
hypocaloric, 1409 kcal/day, 28% pro, 42% cho, 33%
fat
Control diet:
hypocaloric, 1409 kcal/day, 17% pro, 57% cho, 29%
fat
very low carbohydrate diet (low carbohydrate bars
and shakes were provided) vs low fat diet - not
weight loss
Intervention diet:
isocaloric, 1911 kcal/day, 29% pro, 10% cho, 60%
fat
Control diet:
isocaloric, 1576 kcal/day, 17% pro, 62% cho, 19%
fat
very low carbohydrate ketogenic diet weight loss
diet (low carbohydrate bars and shakes were
provided) vs low fat weight loss diet
Intervention diet:
hypocaloric, 1855 kcal/day, 28% pro, 8% cho, 50%
fat
Control diet:
hypocaloric, 1562 kcal/day, 20% pro, 56% cho, 23%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, waist circumference,
blood pressure, total cholesterol,
HDL, LDL, TG, hunger/preoccupation with food
56
BMI, Bone mineral density
120
Weight, total cholesterol, HDL, LDL,
TG
28
Weight
50
23
Primary study
(references)
No of
participants,
losses
Crossover trial
13
Loss to followup and
dropouts: 0%
Characteristics of
patients
overweight ,
obese
BMI 30
0% male
34 years
Location: USA
Volek 2009
(102, 103)
40
Loss to followup and
dropouts: 0%
overweight
BMI I:34; C:32
50% male
I: 33 years, C: 37
years
Location: USA
Wolfe 1991
(104, 105)
Crossover trial
10
Loss to followup and
dropouts: 0%
hyperlipidaemic
weight 64 kg
40% male
50 years
Location:
CANADA
Wolfe 1992
(106, 107)
Crossover trial
5
Loss to followup and
dropouts: 0%
hyperlipidaemic
40% male
48 years
Location:
CANADA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
very low carbohydrate ketogenic diet weight loss
diet (low carbohydrate bars and shakes were
provided) vs low fat weight loss diet
Intervention diet:
hypocaloric, 1288 kcal/day, 28% pro, 9% cho, 63%
fat
Control diet:
hypocaloric, 1243 kcal/day, 19% pro, 59% cho, 21%
fat
very low carbohydrate ketogenic vs low fat diet - no
energy restrictions
Intervention diet:
adlibitum (but was hypocaloric, ) 1504 kcal/day,
28% pro, 12% cho, 59% fat
Control diet:
adlibitum (but was hypocaloric, ) 1478 kcal/day,
20% pro, 56% cho, 24% fat
high protein vs low protein(substituting meat and
dairy protein with carb) weight maintenance
Intervention diet:
isocaloric, 1909 kcal/day, 23% pro, 23%vegetable
protein, 53% cho, 24% fat
Control diet:
isocaloric, 2011 kcal/day, 11% pro, 70% vegetable,
65% cho, 24% fat
weight maintenance high versus low protein
Intervention diet:
isocaloric, 2409 kcal/day, 26% pro, 19% vegetable
protein, 19% cho, 25% fat
Control diet:
isocaloric, 1808 kcal/day, 10% pro, 92% vegetable,
65% cho, 25% fat
Outcomes meeting inclusion criteria
Followup(days)
Weight
30
Weight, BMI, total cholesterol,
HDL, LDL, TG, Fglucose, Finsulin,
CRP
84
Weight, total cholesterol, HDL, LDL,
TG
35
Weight, total cholesterol, HDL, LDL,
TG
35
24
Primary study
(references)
Wolfe 1999
(108, 109)
Yancy 2004
(110, 111)
No of
participants,
losses
Crossover trial
10
Loss to followup and
dropouts: 0%
120
Loss to followup and
dropouts:
26%
Characteristics of
patients
Healthy
Weight 65 kg
20% male
28 years
Location:
CANADA
Obese,
hyperlipidemic
BMI I:35, C:34
26% male
I:44 years, C:46
years
Location: USA
Description of diets included in analyses
(as per authors’ description) and
actual intake reported for each diet
high protein (substitution of mixed carbohydrates
with low-fat, high protein foods) to low protein diet;
not for weight loss; crossover design
Intervention diet:
isocaloric, 2178 kcal/day, 22% pro, 30% vegetable
protein, 43% cho, 35% fat
Control diet:
isocaloric, 2155 kcal/day, 12% pro, 60% vegetable,
53% cho, 35% fat
very low carbohydrate (with increasing carbohydrate
to weight maintenance weekk 10 + mutivitamin and
nutritional supplement) vs low fat low calorie diet
Intervention diet:
ad libitum (but was hypocaloric, ) 1461 kcal/day,
26% pro, 8% cho, 68% fat
Control diet:
hypocaloric, 1502 kcal/day, 19% pro, 52% cho, 29%
fat
Outcomes meeting inclusion criteria
Followup(days)
Weight, BMI, total cholesterol,
HDL, LDL, TG, satiety
28
Weight, BMI, blood pressure, total
cholesterol, HDL, LDL, TG,
creatinine, adverse effects
168
Abbreviations: I, intervention group; C: control group; pro, protein: cho, carbohydrate; BMI, body mass index; Finsulin, fasting serum insulin; Fglucose, fasting serum glucose; HDL,
high density lipoproteins; LDL, low density lipoproteins; TG, triglycerides;
25
References to included studies
NOTE: references ordered by study and articles that were published about each study; *indicates
primary article for study
Note: we highlighted new references from the updated search for the peer reviewers only.
Abete 2009
1.
2.
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Aldrich 2011
3.
Aldrich ND, Reicks MM, Sibley SD, Redmon JB, Thomas W, Raatz SK. Varying protein source and quantity do
not significantly improve weight loss, fat loss, or satiety in reduced energy diets among midlife adults.
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Appel 2005
4.
5.
6.
7.
Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER III, et al. Effects of protein, monounsaturated
fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.
JAMA 2005;294(19):2455-64.
Beasley JM, Ange BA, Anderson CA, Miller ER III, Erlinger TP, Holbrook JT, et al. Associations between
macronutrient intake and self-reported appetite and fasting levels of appetite hormones: results from the
Optimal Macronutrient Intake Trial to Prevent Heart Disease. American Journal of Epidemiology
2009;169(7):893-900.
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carbohydrate intakes on plasma apolipoprotein B and VLDL and LDL containing apolipoprotein C-III: results
from the OmniHeart Trial. American Journal of Clinical Nutrition 2008;87(6):1623-30.
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Aude 2004
8.
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10. Ballesteros-Pomar MD, Calleja-Fernandez AR, Vidal-Casariego A, Urioste-Fondo AM, Cano-Rodriguez I.
Effectiveness of energy-restricted diets with different protein:carbohydrate ratios: the relationship to insulin
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11. Barnard ND, Scialli AR, Turner-McGreivy G, Lanou AJ. Acceptability of a low-fat vegan diet compares favorably
to a Step II Diet in a randomized, controlled trial. Journal of Cardiopulmonary Rehabilitation 2004;24:229-235.
12. Turner-McGrievy GM, Barnard ND, Scialli AR, Lanou AJ, Turner-McGrievy Gabrielle M, Barnard Neal D, et al.
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26
Belobrajdic 2010
13. Belobrajdic DP, Frystyk J, Jeyaratnaganthan N, Espelund U, Flyvbjerg A, Clifton PM, et al. Moderate energy
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17. Brehm BJ, Spang SE, Lattin BL, Seeley RJ, Daniels SR, D'Alessio DA, et al. The role of energy expenditure in the
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18. Brinkworth GD, Noakes M, Buckley JD, Keogh JB, Clifton PM. Long-term effects of a very-low-carbohydrate
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19. Keogh JB, Brinkworth GD, Noakes M, Belobrajdic DP, Buckley JD, Clifton PM. Effects of weight loss from a
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20. Tay J, Brinkworth GD, Noakes M, Keogh J, Clifton PM. Metabolic effects of weight loss on a very-lowcarbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am
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21. Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Renal Function Following Long-Term Weight Loss in
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22. Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term effects of a very low-carbohydrate
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23. Halyburton AK, Brinkworth GD, Wilson CJ, Noakes M, Buckley JD, Keogh JB, et al. Low- and high-carbohydrate
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24. Buscemi S, Verga S, Tranchina MR, Cottone S, Cerasola G. Effects of hypocaloric very-low-carbohydrate diet
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25. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ, Dansinger Michael L, et al. Comparison of the
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Das 2007
27
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de Luis 2007
27. de Luis DA, Aller R, Izaola O, Gonzalez Sagrado M, Bellioo D, Conde R, et al. Effects of a low-fat versus a lowcarbohydrate diet on adipocytokines in obese adults. Hormone Research 2007;67(6):296-300.
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31. Due A, Toubro S, Skov AR, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body
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32. Due A, Toubro S, Stender S, Skov AR, Astrup A, Due A, et al. The effect of diets high in protein or carbohydrate
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33. Skov AR, Haulrik N, Toubro S, Molgaard C, Astrup A. Effect of protein intake on bone mineralization during
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34. Skov AR, Toubro S, Bulow J, Krabbe K, Parving HH, Astrup A, et al. Changes in renal function during weight loss
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35. Skov AR, Toubro S, Ronn B, Holm L, Astrup A, Skov AR, et al. Randomized trial on protein vs carbohydrate in ad
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36. Dyson PA, Beatty S, Matthews DR, Dyson PA, Beatty S, Matthews DR. A low-carbohydrate diet is more
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Farnsworth 2003
37. Farnsworth E, Luscombe ND, Noakes M, Wittert G, Argyiou E, Clifton PM, et al. Effect of a high-protein,
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38. Luscombe ND, Clifton PM, Noakes M, Farnsworth E, Wittert G, Luscombe ND, et al. Effect of a high-protein,
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28
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44. Greene PJ, Devecis J, Willett WC. Effects of low-fat vs ultra-low-carbohydrate weight-loss diets: A 12-week
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47. Iglay HB, Thyfault JP, Apolzan JW, Campbell WW, Iglay Heidi B, Thyfault John P, et al. Resistance training and
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29
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1986;67(1-2):77-86.
32
Seshadri 2005
91. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a
low-fat diet in severe obesity. New England Journal of Medicine 2003;348(21):2074-81.
92. Seshadri P, Samaha FF, Stern L, Ahima RS, Daily D, Iqbal N. Adipocytokine changes caused by lowcarbohydrate compared to conventional diets in obesity. Metabolic Syndrome and Related Disorders
2005;3(1):66-74.
Stamets 2004
93. Stamets K, Taylor DS, Kunselman A, Demers LM, Pelkman CL, Legro RS, et al. A randomized trial of the effects
of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome.
Fertility & Sterility 2004;81(3):630-7.
Stoernell 2008
94. Stoernell CK, Tangney CC, Rockway SW. Short-term changes in lipoprotein subclasses and C-reactive protein
levels of hypertriglyceridemic adults on low-carbohydrate and low-fat diets. Nutrition Research
2008;28(7):443-9.
Te Morenga 2011
95. Te Morenga LA, Levers MT, Williams SM, Brown RC, Mann J. Comparison of high protein and high fiber
weight-loss diets in women with risk factors for the metabolic syndrome: A randomized trial. Nutrition Journal
2011;10(1):40.
Thorpe 2008
96. Thorpe MP, Jacobson EH, Layman DK, He X, Kris-Etherton PM, Evans EM, et al. A diet high in protein, dairy and
calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional
high-carbohydrate diet in adults. Journal of Nutrition 2008;138(6):1096-100.
Volek 2003
97. Volek JS, Sharman MJ, Gomez AL, Scheett TP, Kraemer WJ. An isoenergetic very low carbohydrate diet
improves serum HDL cholesterol and triacylglycerol concentrations, the total cholesterol to HDL cholesterol
ratio and postprandial lipemic responses compared with a low fat diet in normal weight, normolipidemic
women. Journal of Nutrition 2003;133(9):2756-61.
Volek 2004
98. Sharman MJ, Gomez AL, Kraemer WJ, Volek JS. Very low-carbohydrate and low-fat diets affect fasting lipids
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Volek 2009
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104. Wolfe BM, Giovannetti PM. Short-term effects of substituting protein for carbohydrate in the diets of
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106. Wolfe BM, Giovannetti PM. High protein diet complements resin therapy of familial hypercholesterolemia.
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34
Supplement 3: List of excluded studies of interest and primary reason for exclusion
Note: articles of studies which were included but did not provide additional data were excluded.
Excluded study
Reason
Abete 2008
Less than 5% difference in protein between diets
Andreenko 1978
Awaiting translation
Aston 2008
Less than 5% difference in protein between diets
Bopp 2008
Co-intervention could not be separated
Borghi 2002
Co-intervention could not be separated
Chan 2008
Less than 5% difference in protein between diets
Dale 2009
Less than 5% difference in protein between diets
DeLuis 2009
Awaiting translation
DeLuis 2009 (Horm Met Res)
Same study as DeLuis Ann Nut Metab with no additional data
Dewell 2008
Less than 5% difference in protein between diets
Dussol 2008
Less than 5% difference in protein between diets
Erkkila 2008
Less than 5% difference in protein between diets
Gordon 2008
Liquid supplements
Greany 2008
Less than 5% difference in protein between diets
Harrrington 2004
Co-intervention could not be separated
Hays 2004
Less than 5% difference in protein between diets
Hursel 2009
Cannot separate out participants
Jacobs 2009
Less than 5% difference in protein between diets
Kavanagh 2009
Cannot separate out participants
Kirk 2009
Less than 5% difference in protein between diets
Krauss 2006
First phase data not available
Larsen 2010
Less than 5% difference in protein between diets
Lejeune 2005
Protein packet supplements
Lim 2009
Less than 5% difference in protein between diets
Martin 2006
Awaiting reply from author
Raeini-Sarjaz 2001
No reply from author
Sacks 1983
Less than 5% difference in protein between diets
Sagara 2004
No reply from author
Seshadri 2004
More than 20% participants requiring dietary restrictions
Shai 2008
Less than 5% difference in protein between diets
Tsai 2005
More than 20% participants requiring dietary restrictions
Verrillo 1985
Less than 5% difference in protein between diets
Vollmer 2008
Less than 5% difference in protein between diets
Westerterp-Pantenga 2009
Less than 28 days duration
Wycherley 2009
Subgroup of Brinkworth 2009 AJCN with no additional data
35
Supplement 4: Meta-analyses of all health outcomes for change scores
(SD: Standard deviation; IV: inverse variance method; Std: Standard; CI: confidence intervals)
Weight loss
Higher protein
Study or Subgroup Mean SD Total
Abete 2009
-8.5 1.1
9
Aldrich 2011
-5.9 1.45
6
Aude 2004
-6.2 1.8
22
Baba 1999
-8.3 1.9
7
Ballesteros-Pomar 2010 -9 5.53
18
Belobrajdic 2010
-9.3 3.62
34
Brehm 2003
-8.5 4.7
22
Brehm 2005
-6.69 2.2
20
Brinkworth 2009
-13.1 12.1
57
Dansinger 2005
-3.8 3.6
40
Das 2007
-7.8
5
14
Delbridge 2009
3 7.13
42
Due 2004
-6.2 5.6
23
Dyson 2007
-5.8 3.1
6
Foster 2003
-7.2 7.2
33
Greene 2004
-10.5 5.5
7
Greene 2004
-9.1 4.1
7
Jenkins 2009
-3.9
2
25
Keogh 2007
-4.6 5.9
8
Labayen 2003
-9.2 3.7
6
Landers 2002
-4.44 3.21
12
Lasker 2008
-9.1 4.5
25
Layman 2009
-8.2 3.6
52
Lean 1997
-5.4 5.1
53
Leidy 2007
-8.1 1.83
21
Mahon 2007
-6.6 2.7
14
Maki 2007
-4.9 3.2
42
McMillan-Price 2006
-5.3 2.83
32
McMillan-Price 2006b -4.4 2.83
33
Morgan 2009
-6
6.4
57
Noakes 2005
-7.6 2.9
52
Rouse 1986
0.8
0.2
19
Sacks 2009
-5.8 9.9 201
Stamets 2004
-3.7 1.9
13
Stoernell 2008
-1.7 1.5
10
Te Morenga 2011
-4.5 2.4
37
Volek 2003
-1.2 0.8
5
Volek 2004
-3.2 0.5
7
Volek 2004
-8.1 0.7
8
Yancy 2004
-12
6.9
59
Lower protein diets
Std. Mean Difference
Mean
SD Total Weight IV, Random, 95% CI
-4.7
2.9
10 1.8%
-1.62 [-2.69, -0.55]
-5.3 1.86
6 1.6%
-0.33 [-1.48, 0.81]
-3.4
2
23 2.6%
-1.44 [-2.11, -0.78]
-6
1.5
6 1.5%
-1.24 [-2.47, -0.01]
-7.2
4.2
18 2.6%
-0.36 [-1.02, 0.30]
-8.1 3.31
42 3.2%
-0.34 [-0.80, 0.11]
-3.9
4.5
20 2.7%
-0.98 [-1.62, -0.34]
-4.79
2.6
20 2.7%
-0.77 [-1.42, -0.13]
-11.6 12.5
61 3.4%
-0.12 [-0.48, 0.24]
-3.5
3.8
40 3.2%
-0.08 [-0.52, 0.36]
-8
4.1
15 2.5%
0.04 [-0.69, 0.77]
4.3 8.85
40 3.2%
-0.16 [-0.59, 0.27]
-4.3
4.2
18 2.7%
-0.37 [-0.99, 0.25]
-2.8
1.6
4 1.3%
-1.03 [-2.42, 0.36]
-4.4
7.8
30 3.0%
-0.37 [-0.87, 0.13]
-7.7
1.9
3 1.3%
-0.52 [-1.90, 0.86]
-7.7
2.2
4 1.5%
-0.36 [-1.60, 0.89]
-4.2
1.5
25 2.9%
0.17 [-0.39, 0.72]
-5.5
2.7
5 1.7%
0.17 [-0.95, 1.29]
-4.8
2.5
5 1.3%
-1.25 [-2.60, 0.11]
-5.4 2.75
21 2.5%
0.32 [-0.39, 1.03]
-6.9
4
25 2.9%
-0.51 [-1.07, 0.06]
-7
3.6
51 3.3%
-0.33 [-0.72, 0.06]
-4.2
4.5
57 3.3%
-0.25 [-0.62, 0.13]
-9.5
5
25 2.8%
0.35 [-0.23, 0.94]
-5.6
1.8
14 2.4%
-0.42 [-1.17, 0.33]
-2.5
3.2
42 3.2%
-0.74 [-1.19, -0.30]
-3.7 2.83
32 3.0%
-0.56 [-1.06, -0.06]
-4.8 2.83
32 3.1%
0.14 [-0.35, 0.63]
0.6
2.2
61 3.3%
-1.39 [-1.79, -0.99]
-6.9
3.5
48 3.3%
-0.22 [-0.61, 0.18]
-0.25 0.35
20 1.8%
3.58 [2.54, 4.63]
-5.6 12.1 204 3.7%
-0.02 [-0.21, 0.18]
-4.4
1.5
13 2.4%
0.40 [-0.38, 1.17]
-0.7
1.2
13 2.2%
-0.72 [-1.58, 0.13]
-3.3
2.7
37 3.1%
-0.46 [-0.93, -0.00]
-0.8
1
5 1.4%
-0.40 [-1.66, 0.86]
-2.9
0.7
6 1.7%
-0.47 [-1.58, 0.65]
-4.4
0.6
7 0.5%
-5.31 [-7.75, -2.88]
-6.5
7.4
60 3.4%
-0.76 [-1.14, -0.39]
Std. Mean Difference
IV, Random, 95% CI
Total (95% CI)
1158
1168 100.0% -0.36 [-0.56, -0.17]
Heterogeneity: Tau² = 0.25; Chi² = 167.76, df = 39 (P < 0.00001); I² = 77%
-4
-2
0
2
4
Test for overall effect: Z = 3.71 (P = 0.0002)
Favours higher Favours lower
35
36
Change in Body Mass Index
Higher protein diets
Lower protein diets
Mean
SD
Total
Mean
SD
Abete 2009
-3.1
0.53
9
-1.5
0.94
Baba 1999
Study or Subgroup
Std. Mean Difference
Total Weight
IV, Random, 95% CI
10
2.3%
-1.97 [-3.12, -0.83]
-2.7
0.5
7
-2
0.5
6
2.0%
-1.30 [-2.55, -0.06]
Belobrajdic 2010
-3
1.16
34
-2.5
1.23
42
8.3%
-0.41 [-0.87, 0.04]
Brinkworth 2009
-5.2
3.4
33
-4.1
2.4
36
8.0%
-0.37 [-0.85, 0.10]
Dansinger 2005
-1.3
1.2
40
-1.2
1.3
40
8.7%
-0.08 [-0.52, 0.36]
Delbridge 2009
1
2.59
42
1.4
3.16
40
8.8%
-0.14 [-0.57, 0.30]
Due 2004
-2.2
2.1
23
-1.5
2
18
5.9%
-0.33 [-0.96, 0.29]
Dyson 2007
-2.2
1.2
6
-1.1
0.7
4
1.7%
-0.95 [-2.33, 0.42]
Gardner 2007
-1.6
0.98
77
-0.99
1
79
11.1%
-0.61 [-0.93, -0.29]
Johnston 2004
-1.5
0.6
9
-1.8
0.6
7
2.9%
0.47 [-0.53, 1.48]
Lasker 2008
-3.1
1.5
25
-2.4
1.5
25
6.6%
-0.46 [-1.02, 0.10]
Lean 1997
-2.6
2
40
-2.2
1.8
42
8.7%
-0.21 [-0.64, 0.23]
Leidy 2007
-3
0.46
21
-3.4
1.5
25
6.3%
0.34 [-0.24, 0.93]
-2.5
1.1
14
-2.1
0.7
14
4.5%
-0.42 [-1.17, 0.33]
-2.53
3.1
23
-0.98
1.54
22
6.1%
-0.62 [-1.22, -0.02]
-1.7
0.9
37
-1.2
0.9
37
8.2%
-0.55 [-1.01, -0.09]
447 100.0%
-0.37 [-0.56, -0.19]
Mahon 2007
Seshadri 2005
Te Morenga 2011
Total (95% CI)
440
Heterogeneity: Tau² = 0.06; Chi² = 25.71, df = 15 (P = 0.04); I² = 42%
Std. Mean Difference
IV, Random, 95% CI
-2
-1
0
1
2
Favours higher protein Favours lower protein
Test for overall effect: Z = 3.91 (P < 0.0001)
Change in waist circumference
Study or Subgroup
Abete 2009
Higher protein diets
Lower protein diets
Mean
SD
Total
Mean
SD
Std. Mean Difference
-10.6
2.7
9
-6.4
3.3
10
4.0%
Total Weight
IV, Random, 95% CI
-3
3.5
40
-3.5
4.2
40
7.6%
0.13 [-0.31, 0.57]
Delbridge 2009
-0.8
6.48
42
0.92
9.49
40
7.7%
-0.21 [-0.64, 0.22]
Due 2004
-8.4
4.9
23
-1.8
3.7
18
5.8%
-1.47 [-2.17, -0.76]
Greene 2004
-9.7
12.1
7
-6.6
7.1
4
3.1%
-0.26 [-1.50, 0.97]
Greene 2004
-10.9
12.1
7
-6.6
6.2
3
2.7%
-0.36 [-1.72, 1.01]
-4
4.5
8
-7
1.6
5
3.3%
0.75 [-0.42, 1.92]
Lean 1997
-6.5
5
40
-5.7
4.8
41
7.7%
-0.16 [-0.60, 0.27]
Maki 2007
-4.3
4.3
37
-2.8
3.2
42
7.6%
-0.40 [-0.84, 0.05]
McMillan-Price 2006
-6.3
3.39
32
-4.3
3.96
32
7.2%
-0.54 [-1.04, -0.04]
McMillan-Price 2006b
-5
3.96
33
-5.6
3.96
32
7.3%
0.15 [-0.34, 0.64]
Morgan 2009
-8.1
7.4
57
-0.8
3.8
61
8.0%
-1.25 [-1.64, -0.85]
Sacks 2009
-0.05 [-0.24, 0.15]
-6.2
12.8
201
-5.6
11.4
204
9.2%
Stamets 2004
-5
5
13
-1
6
13
5.2%
-0.70 [-1.50, 0.09]
Stoernell 2008
-10.1
5
23
-4.2
6.2
23
6.3%
-1.03 [-1.65, -0.41]
-5.4
2.7
37
-4.7
3.3
37
7.5%
-0.23 [-0.69, 0.23]
605 100.0%
-0.43 [-0.69, -0.16]
Te Morenga 2011
Total (95% CI)
609
Heterogeneity: Tau² = 0.19; Chi² = 60.83, df = 15 (P < 0.00001); I² = 75%
Test for overall effect: Z = 3.18 (P = 0.001)
IV, Random, 95% CI
-1.32 [-2.34, -0.31]
Dansinger 2005
Keogh 2007
Std. Mean Difference
-4
-2
0
2
4
Favours higher protein Favours lower protein
36
37
Change in systolic blood pressure
Higher protein diets
Lower protein diets
Mean
SD
Total
Mean
SD
Abete 2009
-13.3
14.7
9
-3
5.8
Aldrich 2011
-8.7
9.55
6
-2.2
12.5
Appel 2005
-9.5
8.8
82
-8.2
9.1
Brinkworth 2009
-13.8
14.4
33
-14.6
12
Dansinger 2005
-4.1
14
40
-4.8
Delbridge 2009
1.9
18.1
42
Foster 2003
-1.9
14.7
Gardner 2007
-6.8
8
Lean 1997
-0.3
Leidy 2007
-5
Maki 2007
Morgan 2009
Study or Subgroup
Stamets 2004
Std. Mean Difference
Total Weight
10
IV, Random, 95% CI
1.4%
-0.90 [-1.86, 0.06]
6
1.0%
-0.54 [-1.70, 0.62]
82
14.0%
-0.14 [-0.45, 0.16]
36
5.9%
0.06 [-0.41, 0.53]
13
40
6.8%
0.05 [-0.39, 0.49]
7.5
14.5
40
6.9%
-0.34 [-0.77, 0.10]
33
3.6
19.5
30
5.3%
-0.32 [-0.81, 0.18]
77
-3.6
6.9
79
13.0%
-0.43 [-0.74, -0.11]
17.3
36
-1.1
16.7
38
6.3%
0.05 [-0.41, 0.50]
9.17
21
-3
10
25
3.9%
-0.20 [-0.79, 0.38]
-0.6
13
42
-1.2
14.9
42
7.2%
0.04 [-0.39, 0.47]
-7.2
11.6
57
-2.8
11.8
61
9.9%
-0.37 [-0.74, -0.01]
-4
13
13
-3
13
13
2.2%
-0.07 [-0.84, 0.69]
Te Morenga 2011
-5.4
9
37
-1.7
8.1
37
6.2%
-0.43 [-0.89, 0.03]
Yancy 2004
-9.6
14
59
-7.5
15.7
60
10.1%
-0.14 [-0.50, 0.22]
599 100.0%
-0.21 [-0.32, -0.09]
Total (95% CI)
587
Heterogeneity: Tau² = 0.00; Chi² = 11.84, df = 14 (P = 0.62); I² = 0%
Std. Mean Difference
IV, Random, 95% CI
-4
-2
0
2
4
Favours higher protein Favours lower protein
Test for overall effect: Z = 3.56 (P = 0.0004)
Change in diastolic blood pressure
Higher protein diets
Lower protein diets
Mean
SD
Total
Mean
SD
-5
10.4
9
-5.5
7.2
Aldrich 2011
-4.3
5.14
6
3.8
10.3
Appel 2005
-5.2
3.9
82
-4.1
3.9
Brinkworth 2009
-6.3
9.2
33
-7.9
9.6
36
5.9%
0.17 [-0.31, 0.64]
Dansinger 2005
-4.8
7.6
40
-3.1
7.4
40
6.8%
-0.22 [-0.66, 0.22]
0.00 [-0.43, 0.43]
Study or Subgroup
Abete 2009
Delbridge 2009
Std. Mean Difference
Total Weight
10
IV, Random, 95% CI
1.6%
0.05 [-0.85, 0.95]
6
0.9%
-0.92 [-2.14, 0.30]
82
13.6%
-0.28 [-0.59, 0.03]
3.7
14.3
42
3.7
12
40
7.0%
Foster 2003
-4.6
11.6
33
-5.2
13.3
30
5.4%
0.05 [-0.45, 0.54]
Gardner 2007
-2.9
6.2
77
-1.4
4.4
79
13.0%
-0.28 [-0.59, 0.04]
Lean 1997
-2.3
11.2
36
-2.7
11.4
38
6.4%
0.04 [-0.42, 0.49]
Leidy 2007
-4
4.58
21
-6
10
25
3.9%
0.25 [-0.34, 0.83]
Maki 2007
-3.3
11.7
42
-0.6
9.1
42
7.1%
-0.26 [-0.68, 0.17]
Morgan 2009
-4.9
8.1
57
-1.6
7.4
61
9.8%
-0.42 [-0.79, -0.06]
Stamets 2004
0
18
13
0
11
13
2.3%
0.00 [-0.77, 0.77]
-4.7
6
37
-0.9
6.6
37
6.1%
-0.60 [-1.06, -0.13]
-6
7.9
59
-5.2
8.9
60
10.1%
-0.09 [-0.45, 0.27]
599 100.0%
-0.18 [-0.29, -0.06]
Te Morenga 2011
Yancy 2004
Total (95% CI)
587
Heterogeneity: Tau² = 0.00; Chi² = 14.27, df = 14 (P = 0.43); I² = 2%
Test for overall effect: Z = 3.01 (P = 0.003)
Std. Mean Difference
IV, Random, 95% CI
-4
-2
0
2
4
Favours higher protein Favours lower protein
37
38
Change in total cholesterol
Higher protein
Lower protein diets
Std. Mean Difference
Study or Subgroup Mean SD Total Mean
SD Total Weight IV, Random, 95% CI
Abete 2009
-0.41
Appel 2005
-0.51
Aude 2004
-0.31
Baba 1999
-1.27
Brinkworth 2009
0.7
Dansinger 2005
-0.48
Das 2007
-0.3
Delbridge 2009
0.54
Dyson 2007
0.2
Foster 2003
0.01
Lean 1997
-0.12
Leidy 2007
-0.83
Mahon 2007
-0.59
Maki 2007
-0.32
McMillan-Price 2006 0.24
McMillan-Price 2006b -0.05
Morgan 2009
-0.3
Noakes 2005
-0.48
Stamets 2004
-0.7
Te Morenga 2011
-0.6
Yancy 2004
-0.21
Total (95% CI)
0.61
0.42
0.76
1.16
1.1
0.65
0.48
0.84
0.6
0.66
0.9
0.71
0.93
0.44
0.56
0.56
0.8
0.7
1.19
0.54
0.8
9
82
22
7
33
40
14
42
6
33
37
21
14
39
32
33
57
52
13
37
59
682
-0.32
-0.32
-0.34
-0.86
0.1
-0.38
0
0.36
-0.1
-0.28
-0.34
-0.75
-1.14
-0.21
0.05
-0.18
-0.5
-0.33
-0.47
-0.5
-0.35
0.5
0.39
0.45
0.1
0.6
0.67
0.41
1.08
0.2
0.52
0.7
0.65
1.71
0.59
0.56
0.56
0.18
0.6
0.39
0.6
1.4
10
82
23
6
36
40
15
40
4
30
40
25
14
38
32
32
61
48
13
37
60
2.3%
7.7%
4.2%
1.6%
5.3%
5.8%
3.0%
5.9%
1.2%
5.1%
5.7%
4.3%
3.0%
5.7%
5.2%
5.2%
6.9%
6.4%
2.9%
5.6%
6.9%
-0.16 [-1.06, 0.75]
-0.47 [-0.78, -0.16]
0.05 [-0.54, 0.63]
-0.44 [-1.55, 0.67]
0.68 [0.19, 1.16]
-0.15 [-0.59, 0.29]
-0.66 [-1.41, 0.10]
0.18 [-0.25, 0.62]
0.55 [-0.75, 1.86]
0.48 [-0.02, 0.98]
0.27 [-0.18, 0.72]
-0.12 [-0.70, 0.46]
0.39 [-0.36, 1.14]
-0.21 [-0.66, 0.24]
0.34 [-0.16, 0.83]
0.23 [-0.26, 0.72]
0.35 [-0.02, 0.71]
-0.23 [-0.62, 0.17]
-0.25 [-1.02, 0.52]
-0.17 [-0.63, 0.28]
0.12 [-0.24, 0.48]
686 100.0%
0.04 [-0.11, 0.20]
Heterogeneity: Tau² = 0.05; Chi² = 37.09, df = 20 (P = 0.01); I² = 46%
Test for overall effect: Z = 0.57 (P = 0.57)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
Favours higher
0
1
2
Favours lower
38
39
Change in high density lipoprotein
Higher protein
lower protein diet
Std. Mean Difference
Study or SubgroupMean SD Total Mean
SD Total Weight IV, Random, 95% CI
Abete 2009
-0.24
Appel 2005
-0.07
Aude 2004
-0.03
Baba 1999
-0.12
Brinkworth 2009
0.3
Dansinger 2005
0.05
Das 2007
0.16
Delbridge 2009
0.18
Dyson 2007
0.08
Foster 2003
0.22
Gardner 2007
-0.01
Greene 2004
0
Greene 2004
-0.03
Johnston 2004
-0.2
Lean 1997
0.05
Leidy 2007
-0.23
Mahon 2007
-0.05
Maki 2007
-0.01
McMillan-Price 2006 0.07
McMillan-Price 2006 0.05
Morgan 2009
-0.1
Noakes 2005
-0.09
Stamets 2004
0.18
Te Morenga 2011
-0.1
Yancy 2004
0.14
Total (95% CI)
0.41
0.12
0.24
0.13
0.4
0.2
0.13
0.26
0.17
0.27
0.2
0.2
0.2
0.2
0.02
0.12
0.28
0.2
0.23
0.23
0.1
0.1
0.8
0.12
0.31
9
82
22
7
33
40
14
42
6
33
77
7
7
9
34
21
14
39
33
32
57
52
13
37
59
779
-0.21
-0.04
-0.1
0.09
0.07
0.01
0.19
0.16
0.06
0.04
-0.1
-0.07
-0.07
-0.3
-0.02
-0.16
-0.31
-0.05
0.03
0.08
-0.2
-0.09
-0.08
-0.1
-0.04
0.41
0.13
0.16
0.13
0.4
0.05
0.23
0.19
0.23
0.19
0.2
0.1
0.1
0.3
0.2
0.26
0.44
0.1
0.23
0.23
0.04
0.1
0.13
0.18
0.29
10
82
23
6
36
40
15
40
4
30
79
3
4
7
37
25
14
38
32
32
61
48
13
37
60
2.6%
5.9%
4.1%
1.6%
4.7%
5.0%
3.3%
5.0%
1.6%
4.5%
5.8%
1.4%
1.7%
2.3%
4.8%
4.1%
3.2%
4.9%
4.7%
4.7%
5.3%
5.3%
3.1%
4.9%
5.5%
-0.07 [-0.97, 0.83]
-0.24 [-0.55, 0.07]
0.34 [-0.25, 0.93]
-1.50 [-2.79, -0.21]
0.57 [0.09, 1.05]
0.27 [-0.17, 0.71]
-0.15 [-0.88, 0.57]
0.09 [-0.35, 0.52]
0.09 [-1.17, 1.36]
0.76 [0.24, 1.27]
0.45 [0.13, 0.77]
0.35 [-1.02, 1.72]
0.21 [-1.02, 1.44]
0.38 [-0.62, 1.38]
0.48 [0.00, 0.95]
-0.33 [-0.91, 0.25]
0.68 [-0.08, 1.45]
0.25 [-0.20, 0.70]
0.17 [-0.32, 0.66]
-0.13 [-0.62, 0.36]
1.32 [0.92, 1.72]
0.00 [-0.39, 0.39]
0.44 [-0.34, 1.22]
0.00 [-0.46, 0.46]
0.60 [0.23, 0.96]
776 100.0%
0.25 [0.07, 0.44]
Heterogeneity: Tau² = 0.13; Chi² = 68.17, df = 24 (P < 0.00001); I² = 65%
Test for overall effect: Z = 2.71 (P = 0.007)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
Favours lower
0
1
2
Favours higher
39
40
Change in low density lipoprotein
Higher protein
lower protein diet
Std. Mean Difference
Study or SubgroupMean SD Total Mean
SD Total Weight IV, Random, 95% CI
Abete 2009
-0.14
Appel 2005
-0.37
Aude 2004
-0.1
Baba 1999
-0.55
Brinkworth 2009
0.6
Dansinger 2005
0.25
Delbridge 2009
0.33
Dyson 2007
0.16
Foster 2003
0.02
Gardner 2007
0.06
Greene 2004
-0.34
Greene 2004
-0.36
Jenkins 2009
-0.9
Johnston 2004
-0.3
Lean 1997
0.03
Leidy 2007
-0.47
Mahon 2007
-0.44
Maki 2007
-0.18
McMillan-Price 2006 0.26
McMillan-Price 2006 -0.04
Morgan 2009
-0.2
Noakes 2005
-0.26
Stamets 2004
0.34
Te Morenga 2011
-0.4
Yancy 2004
0.04
0.13
0.39
0.71
0.94
1.1
0.7
0.58
0.42
0.71
0.6
0.6
0.7
0.62
0.4
0.8
0.59
0.7
0.4
0.57
0.57
0.1
0.6
0.5
0.42
0.97
Total (95% CI)
9
82
22
7
33
40
42
6
33
77
7
7
25
9
34
21
14
39
32
33
57
52
13
37
59
-0.09
-0.3
-0.17
-0.56
0.1
0.31
-1.4
-0.17
-0.18
0.19
-0.52
-0.52
-0.5
-0.4
-0.17
-0.57
-0.52
-0.09
0.04
-0.17
-0.1
-0.19
0.3
-0.3
-0.19
0.2
0.36
0.4
0.34
0.6
0.6
9.49
0.21
0.5
0.5
0.5
0.5
0.57
0.6
0.6
0.52
1.29
0.5
0.57
0.57
0.08
0.6
0.4
0.48
1.1
790
10
82
23
6
36
40
40
4
30
79
4
3
25
7
37
25
14
38
32
32
61
48
13
37
60
2.4%
6.1%
4.0%
1.8%
4.7%
5.0%
5.1%
1.3%
4.6%
6.0%
1.5%
1.3%
4.0%
2.1%
4.8%
4.0%
3.1%
5.0%
4.6%
4.6%
5.4%
5.4%
2.9%
4.9%
5.7%
-0.28 [-1.19, 0.63]
-0.19 [-0.49, 0.12]
0.12 [-0.46, 0.71]
0.01 [-1.08, 1.10]
0.56 [0.08, 1.05]
-0.09 [-0.53, 0.35]
0.26 [-0.18, 0.69]
0.84 [-0.51, 2.19]
0.32 [-0.18, 0.82]
-0.23 [-0.55, 0.08]
0.29 [-0.95, 1.53]
0.22 [-1.14, 1.58]
-0.66 [-1.23, -0.09]
0.19 [-0.80, 1.18]
0.28 [-0.19, 0.75]
0.18 [-0.40, 0.76]
0.07 [-0.67, 0.82]
-0.20 [-0.64, 0.25]
0.38 [-0.11, 0.88]
0.23 [-0.26, 0.71]
-1.10 [-1.49, -0.71]
-0.12 [-0.51, 0.28]
0.09 [-0.68, 0.85]
-0.22 [-0.68, 0.24]
0.22 [-0.14, 0.58]
786 100.0%
-0.00 [-0.17, 0.16]
Heterogeneity: Tau² = 0.09; Chi² = 57.95, df = 24 (P = 0.0001); I² = 59%
Test for overall effect: Z = 0.04 (P = 0.97)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
Favours higher
0
1
2
Favours lower
Change in C-reactive protein
Higher protein
lower protein diet
Std. Mean Difference
Study or SubgroupMean SD Total Mean
SD Total Weight IV, Random, 95% CI
Brinkworth 2009
-1.3 1.1
Dansinger 2005
-0.22 1.9
Mahon 2007
0
1.5
McMillan-Price 2006 -0.01 2.26
McMillan-Price 2006 -0.8 2.26
Noakes 2005
-1.7 2.9
Total (95% CI)
31 -1.4
40 -0.04
14 -0.6
33 -1.1
32 -0.8
52 -0.8
202
1.8
1.2
4
2.26
2.26
2.1
30
40
14
32
32
48
16.2%
19.5%
8.8%
16.6%
16.8%
22.2%
0.07 [-0.44, 0.57]
-0.11 [-0.55, 0.33]
0.19 [-0.55, 0.94]
0.48 [-0.02, 0.97]
0.00 [-0.49, 0.49]
-0.35 [-0.75, 0.04]
196 100.0%
0.01 [-0.23, 0.25]
Heterogeneity: Tau² = 0.03; Chi² = 7.17, df = 5 (P = 0.21); I² = 30%
Test for overall effect: Z = 0.06 (P = 0.95)
Std. Mean Difference
IV, Random, 95% CI
-4
-2
Favours higher
0
2
Favours lower
4
40
41
Change in HbA1c
Higher protein
Lower protein diet
Mean Difference
Study or Subgroup Mean SD Total Mean
SD Total Weight IV, Random, 95% CI
Dyson 2007
Iglay 2007
Seshadri 2005
Subtotal (95% CI)
-0.2 0.2
0
0
-0.17 0.58
6
17
23
46
-0.2
0
-0.16
0.2
0
0.4
4 56.8%
15
22 43.2%
41 100.0%
Mean Difference
IV, Random, 95% CI
0.00 [-0.25, 0.25]
Not estimable
-0.01 [-0.30, 0.28]
-0.00 [-0.19, 0.19]
Heterogeneity: Tau² = 0.00; Chi² = 0.00, df = 1 (P = 0.96); I² = 0%
Test for overall effect: Z = 0.04 (P = 0.96)
-0.5
-0.25
Favours higher
0
0.25
0.5
Favours lower
Change in fasting blood glucose
Higher protein diet
Lower protein diet
Mean
SD
Total
Mean
SD
Abete 2009
-0.24
0.51
9
-0.17
0.35
Baba 1999
-0.44
0.31
7
-0.04
-0.3
0.34
34
-0.2
Bowden 2007
-0.29
0.27
15
Bowden 2007
-0.28
0.52
Brinkworth 2009
-0.3
Dansinger 2005
Study or Subgroup
Std. Mean Difference
Total Weight
IV, Random, 95% CI
10
2.4%
-0.15 [-1.06, 0.75]
0.38
6
1.4%
-1.08 [-2.28, 0.12]
0.76
42
7.3%
-0.16 [-0.62, 0.29]
0.04
0.88
34
4.6%
-0.43 [-1.05, 0.18]
7
-0.08
0.65
38
2.9%
-0.31 [-1.12, 0.50]
0.1
33
-0.3
0.6
36
6.9%
0.00 [-0.47, 0.47]
-0.5
1.6
40
-0.3
1.3
40
7.6%
-0.14 [-0.57, 0.30]
Gardner 2007
0
0.4
77
0
0.5
79
11.1%
0.00 [-0.31, 0.31]
Johnston 2004
0
0.7
9
-0.2
0.6
7
2.0%
0.29 [-0.71, 1.28]
Lasker 2008
-0.28
0.65
25
-0.52
0.6
25
5.4%
0.38 [-0.18, 0.94]
Leidy 2007
-0.04
0.5
21
-0.39
0.28
25
4.7%
0.87 [0.26, 1.48]
Maki 2007
-0.2
0.4
39
0
0.4
39
7.3%
-0.50 [-0.95, -0.04]
McMillan-Price 2006
-0.05
0.57
32
0.04
0.57
32
6.5%
-0.16 [-0.65, 0.33]
McMillan-Price 2006
0.02
0.57
33
-0.06
0.57
32
6.6%
0.14 [-0.35, 0.63]
Morgan 2009
-0.2
0.5
57
-0.1
0.5
61
9.6%
-0.20 [-0.56, 0.16]
Noakes 2005
-0.21
0.4
52
-0.25
0.5
48
8.7%
0.09 [-0.30, 0.48]
Seshadri 2005
0.08
0.8
23
0.09
0.1
22
5.0%
-0.02 [-0.60, 0.57]
576 100.0%
-0.05 [-0.20, 0.10]
Belobrajdic 2010
Total (95% CI)
513
Heterogeneity: Tau² = 0.03; Chi² = 22.38, df = 16 (P = 0.13); I² = 29%
Test for overall effect: Z = 0.70 (P = 0.49)
Std. Mean Difference
IV, Random, 95% CI
-4
-2
0
2
4
Favours higher protein Favours lower protein
41
42
Change in triglycerides
Higher protein
lower protein diet
Std. Mean Difference
Study or SubgroupMean SD Total Mean
SD Total Weight IV, Random, 95% CI
Abete 2009
-0.05
Appel 2005
-0.19
Aude 2004
-0.47
Baba 1999
-1.24
Brinkworth 2009
-0.58
Dansinger 2005
-0.61
Delbridge 2009
0.13
Dyson 2007
-0.1
Foster 2003
-0.42
Gardner 2007
-0.59
Greene 2004
-1.05
Greene 2004
-0.64
Jenkins 2009
-0.6
Johnston 2004
-0.2
Lean 1997
-0.25
Leidy 2007
-0.25
Mahon 2007
-0.26
Maki 2007
-0.28
McMillan-Price 2006 -0.19
McMillan-Price 2006 -0.18
Morgan 2009
-0.6
Noakes 2005
-0.3
Seshadri 2005
-0.52
Stamets 2004
-0.33
Te Morenga 2011
-0.3
Yancy 2004
-0.84
0.47
0.47
1.14
1.15
0.6
1.2
0.97
0.4
0.35
0.8
0.33
0.6
0.59
0.3
0.5
0.52
0.56
0.4
0.4
0.4
0.1
0.7
1
1
0.36
1.9
Total (95% CI)
9
82
22
7
33
40
42
6
33
77
7
7
25
9
34
21
14
39
33
32
57
52
23
13
37
59
-0.03
0
-0.17
-0.85
-0.22
-0.1
0.3
-0.1
0.02
-0.19
-0.78
-0.78
-0.4
0.1
-0.27
-0.14
-0.11
-0.13
-0.05
-0.14
-0.1
-0.11
0.05
-0.23
-0.2
-0.31
0.63
0.45
0.52
0.75
0.7
0.4
0.7
0.4
0.58
0.6
0.6
0.7
0.47
0.5
0.5
0.45
0.78
0.5
0.4
0.4
0.1
0.4
0.5
0.6
0.33
1.1
813
10
82
23
6
36
40
40
4
30
79
3
4
25
7
39
25
14
38
32
32
61
48
22
13
37
60
3.2%
4.7%
4.0%
2.7%
4.3%
4.4%
4.4%
2.4%
4.2%
4.6%
2.2%
2.5%
4.1%
2.9%
4.3%
4.0%
3.6%
4.4%
4.3%
4.3%
3.6%
4.5%
4.0%
3.6%
4.3%
4.6%
-0.03 [-0.93, 0.87]
-0.41 [-0.72, -0.10]
-0.34 [-0.92, 0.25]
-0.37 [-1.47, 0.74]
-0.54 [-1.03, -0.06]
-0.56 [-1.01, -0.12]
-0.20 [-0.63, 0.24]
0.00 [-1.27, 1.27]
-0.92 [-1.44, -0.40]
-0.56 [-0.88, -0.24]
-0.59 [-1.98, 0.80]
0.20 [-1.03, 1.43]
-0.37 [-0.93, 0.19]
-0.71 [-1.74, 0.32]
0.04 [-0.42, 0.50]
-0.22 [-0.81, 0.36]
-0.21 [-0.96, 0.53]
-0.33 [-0.78, 0.12]
-0.35 [-0.84, 0.14]
-0.10 [-0.59, 0.39]
-4.97 [-5.71, -4.23]
-0.33 [-0.72, 0.07]
-0.70 [-1.31, -0.10]
-0.12 [-0.89, 0.65]
-0.29 [-0.74, 0.17]
-0.34 [-0.70, 0.02]
810 100.0%
-0.51 [-0.78, -0.24]
Heterogeneity: Tau² = 0.39; Chi² = 162.19, df = 25 (P < 0.00001); I² = 85%
Test for overall effect: Z = 3.69 (P = 0.0002)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
Favours higher
0
1
2
Favours lower
Change in fasting blood insulin
Higher protein
Lower protein diets
Std. Mean Difference
Study or Subgroup Mean SD Total Mean
SD Total Weight IV, Random, 95% CI
Abete 2009
-36
Baba 1999
-120.8
Brinkworth 2009
-23.6
Dansinger 2005
-49.3
Das 2007
-18
Gardner 2007
-20.8
Maki 2007
-2.8
McMillan-Price 2006 -17.1
McMillan-Price 2006b -10.4
Noakes 2005
-1.9
Seshadri 2005
-64.2
Total (95% CI)
24.1
55.6
23.9
83.3
14.5
27.1
47.9
39.6
39.1
25
135.6
9
7
33
40
14
77
39
32
33
52
23
359
-7.7 48.1
-97.9 76.4
-22.9 20.8
-12.5 41.7
-14 11.3
-13.2 32.6
6.3 47.9
-8.1
39
-13.3
39
-11.1 43.1
76.4 262.5
10
6
36
40
15
79
39
32
32
48
22
3.2%
2.4%
10.2%
11.1%
5.0%
17.5%
11.2%
9.6%
9.8%
13.2%
7.0%
-0.70 [-1.63, 0.24]
-0.32 [-1.42, 0.78]
-0.03 [-0.50, 0.44]
-0.55 [-1.00, -0.11]
-0.30 [-1.03, 0.43]
-0.25 [-0.57, 0.06]
-0.19 [-0.63, 0.26]
-0.23 [-0.72, 0.27]
0.07 [-0.41, 0.56]
0.26 [-0.13, 0.66]
-0.67 [-1.27, -0.06]
359 100.0%
-0.20 [-0.37, -0.03]
Heterogeneity: Tau² = 0.02; Chi² = 13.00, df = 10 (P = 0.22); I² = 23%
Test for overall effect: Z = 2.26 (P = 0.02)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
Favours higher
0
1
Favours lower
2
42
43
Change bone mineral density
Higher protein
lower protein diet
Mean Difference
Study or SubgroupMean
SD Total Mean
SD Total Weight IV, Random, 95% CI
2.14.1 total body
Due 2004
1.17 0.05
25 1.17 0.05
Mahon 2007
1.126 0.0935 14 1.107 0.0973
Thorpe 2008
2.1
2.5
28
1.7
2.5
Thorpe 2008
1.5
2.3
36
1.1
1.9
Subtotal (95% CI)
103
25 86.6%
14 13.3%
31 0.0%
35 0.1%
105 100.0%
Mean Difference
IV, Random, 95% CI
0.00 [-0.03, 0.03]
0.02 [-0.05, 0.09]
0.40 [-0.88, 1.68]
0.40 [-0.58, 1.38]
0.00 [-0.02, 0.03]
Heterogeneity: Tau² = 0.00; Chi² = 1.24, df = 3 (P = 0.74); I² = 0%
Test for overall effect: Z = 0.23 (P = 0.82)
2.14.2 lumbar spine
Due 2004
Thorpe 2008
Thorpe 2008
Subtotal (95% CI)
1.04
2.4
1.3
0.1
4.2
2.9
25
28
36
89
1.01
0.6
0.5
0.15
1.9
1.7
25
31
35
91
50.8%
19.2%
30.0%
100.0%
0.03 [-0.04, 0.10]
1.80 [0.11, 3.49]
0.80 [-0.30, 1.90]
0.60 [-0.34, 1.54]
Heterogeneity: Tau² = 0.45; Chi² = 6.04, df = 2 (P = 0.05); I² = 67%
Test for overall effect: Z = 1.25 (P = 0.21)
2.14.3 hip
Thorpe 2008
Thorpe 2008
Subtotal (95% CI)
-0.2
-0.2
2.5
2.2
36
28
64
-0.7
-0.9
2.1
1.7
35 47.0%
31 53.0%
66 100.0%
0.50 [-0.57, 1.57]
0.70 [-0.31, 1.71]
0.61 [-0.13, 1.34]
Heterogeneity: Tau² = 0.00; Chi² = 0.07, df = 1 (P = 0.79); I² = 0%
Test for overall effect: Z = 1.61 (P = 0.11)
-2 -1
Favours lower
0
1
2
Favours higher
Change in creatinine (umol/L)
Higher protein
Study or Subgroup Mean
Greene 2004
Greene 2004
Leidy 2007
Total (95% CI)
Lower protein diet Mean Difference
SD Total Mean
-6.2 17.7
-2.7 9.4
1.8 4.1
7
7
21
35
Mean Difference
IV, Random, 95% CI
SD Total Weight IV, Random, 95% CI
-9.7 10.7
-9.7 12.4
-4.4 8.8
3 4.2% 3.50 [-14.35, 21.35]
4 6.8% 7.00 [-7.01, 21.01]
25 89.0% 6.20 [2.33, 10.07]
32 100.0%
6.14 [2.49, 9.79]
Heterogeneity: Tau² = 0.00; Chi² = 0.10, df = 2 (P = 0.95); I² = 0%
Test for overall effect: Z = 3.30 (P = 0.0010)
-100
-50
Favours lower
0
50
100
Favours higher
Satiety
Higher protein
Study or Subgroup Mean
SD Total
Aldrich 2011
61 14.6969 6
Aude 2004
4.2
0.9 29
Jenkins 2009
1.5
1.5 25
Johnston 2004
5
0.5
9
Nickols-Richardson 2005-3.2
2.4 13
Sacks 2009
64.1
18.9 164
Wolfe 1999
6.1
1.3
5
Lower protein diets Std. Mean Difference
Mean
SD Total Weight IV, Random, 95% CI
58 14.6969 6 6.1%
0.19 [-0.95, 1.32]
3.6
1.2 25 18.0%
0.56 [0.02, 1.11]
0.8
1.5 25 17.4%
0.46 [-0.10, 1.02]
4.22
1.1
7 7.0%
0.91 [-0.15, 1.96]
-5.9
3.8 15 11.2%
0.81 [0.03, 1.59]
63.5
20.4 164 35.5%
0.03 [-0.19, 0.25]
5.4 0.0000001 5 4.8%
0.69 [-0.61, 1.99]
Total (95% CI)
251
247 100.0%
Heterogeneity: Tau² = 0.05; Chi² = 9.52, df = 6 (P = 0.15); I² = 37%
Test for overall effect: Z = 2.53 (P = 0.01)
Std. Mean Difference
IV, Random, 95% CI
0.39 [0.09, 0.69]
-4
-2
Favours lower
0
2
4
Favours higher
43
44
Supplement 5: Meta-regression results by outcome (primary and full adjusted models)
Note: any changes from the last analysis are highlighted in yellow for the peer reviewer
Note for all models:
† Protein is difference in % of total energy intake between intervention and control diet.
‡ Difference in total energy intake between intervention and control diet.
§ Percent male > 0% versus 0% male (since studies with 0% male were over-represented).
¶ Carbohydrates is difference in % of total energy intake between intervention and control diet.
Models for mean difference in body weight. (N=2,542 participants; 34 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
7.904 *
Protein †
Full Adjusted Model
95% C.I.
2.816, 12.992 *
Beta
Coefficient
8.383 *
0.054
-0.069, 0.177
0.082
-0.058, 0.222
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.0009
-0.003, 0.005
0.001
-0.003, 0.005
-0.467*
-0.877, -0.057 *
-0.393
-0.903, 0.117
Body mass index, kg/m2
-0.309*
-0.474, -0.144 *
-0.282*
-0.458, -0.106 *
Age, years
-0.001
-0.079, 0.077
% male §
-0.670
-1.875, 0.535
Carbohydrates, % of
energy intake ¶
0.023
-0.015, 0.061
2.465, 14.301 *
Models for mean difference in body mass index. (N=1,176 participants; 15 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
2.611
Protein †
Full Adjusted Model
95% C.I.
-0.837, 6.059
Beta
Coefficient
5.360 *
0.014
-0.041, 0.069
0.069 *
0.015, 0.123 *
Duration of diet
intervention, days
Energy, 100 kcals ‡
-0.0003
-0.003, 0.003
0.0004
-0.002, 0.003
-0.173
-0.370, 0.025
-0.304 *
-0.468, -0.140 *
Body mass index, kg/m2
-0.097
-0.202, 0.008
-0.110 *
-0.198, -0.022 *
Age, years
-0.029
-0.060, 0.002
% male §
-0.399
-0.860, 0.062
Carbohydrates, % of
energy intake ¶
0.054 *
0.025, 0.083 *
1.703, 9.017 *
44
45
Models for mean difference in waist circumference. (N=1,413 participants; 14 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
-19.735
Protein †
Full Adjusted Model
95% C.I.
-52.5, 13.0
Beta
Coefficient
-21.5
0.378
-0.390, 1.146
0.619
-0.422, 1.660
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.0003
-0.009, 0.010
-0.0001
-0.012, 0.012
-0.866
-2.373, 0.641
-0.728
-2.627, 1.171
Body mass index, kg/m2
0.45
-0.503, 1.403
0.456
-0.710, 1.622
Age, years
0.123
-0.277, 0.523
% male §
-2.064
-7.068, 2.940
Carbohydrates, % of
energy intake ¶
0.154
-0.185, 0.493
-59.4, 16.4
Models for mean difference in systolic blood pressure. (N=1,259 participants; 13 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
0.318
Protein †
Duration of diet
intervention, days
Energy, 100 kcals ‡
Full Adjusted Model
95% C.I.
-42.0, 42.654
Beta
Coefficient
-10.6
0.121
-0.796, 1.038
-0.805
-1.995, 0.385
0.004
-0.018, 0.026
0.005
-0.020, 0.030
-1.152
-2.579, 0.275
-0.115
-1.793, 1.563
-0.139
-1.329, 1.051
-0.326
-1.567, 0.915
Age, years
0.573 *
0.089, 1.057 *
% male §
-2.22
-6.022, 1.582
Carbohydrates, % of
energy intake ¶
-0.077
-0.249, 0.095
Body mass index, kg/m
2
-57.4, 36.2
45
46
Models for mean difference in diastolic blood pressure. (N=1,259 participants; 13 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
-15.9
Protein †
Full Adjusted Model
95% C.I.
-43.9, 12.1
Beta
Coefficient
-16.5
0.602
-0.022, 1.226
0.331
-0.561, 1.223
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.005
-0.009, 0.019
0.006
-0.012, 0.024
-0.470
-1.456, 0.516
-0.205
-1.405, 0.995
Body mass index, kg/m2
0.279
-0.499, 1.057
0.175
-0.656, 1.006
Age, years
0.149
-0.192, 0.490
% male §
-0.966
-3.651, 1.719
Carbohydrates, % of
energy intake ¶
-0.033
-0.145, 0.079
-46.7, 13.7
Models for mean difference in total cholesterol. (N=1,686 participants; 19 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
-0.999
Protein †
Duration of diet
intervention, days
Energy, 100 kcals ‡
Full Adjusted Model
95% C.I.
-2.367, 0.369
Beta
Coefficient
-0.780
-0.009
-0.040, 0.022
-0.015
-0.048, 0.018
0.001
-0.0001, 0.002
0.0005
-0.001, 0.002
0.026
-0.066, 0.118
0.004
-0.110, 0.118
0.030
-0.011, 0.071
0.028
-0.013, 0.069
Age, years
-0.005
-0.021, 0.011
% male §
-0.003
-0.260, 0.254
Carbohydrates, % of
energy intake ¶
-0.009
-0.021, 0.003
Body mass index, kg/m
2
-2.416, 0.857
46
47
Models for mean difference in HDL-cholesterol. (N=1,715 participants; 22 studies)
Primary Model
Full Adjusted Model
95% C.I.
Beta
Coefficient
95% C.I.
Intercept
Beta
Coefficien
t
-0.074
-0.533, 0.385
-0.158
-0.534, 0.218
Protein †
-0.0004
-0.010, 0.009
-0.007 *
-0.013, -0.001 *
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.0001
-0.0002, 0.0005
0.0001
-0.0002, 0.0003
-0.011
-0.046, 0.024
-0.006
-0.031, 0.019
Body mass index, kg/m2
0.003
-0.011, 0.017
0.003
-0.007, 0.013
Age, years
0.0008
-0.003, 0.005
% male §
0.010
-0.029, 0.049
Carbohydrates, % of
energy intake ¶
-0.005 *
-0.007, -0.003 *
Models for mean difference in LDL-cholesterol. (N=1,765 participants; 23 studies)
Primary Model
95% C.I.
Full Adjusted Model
Intercept
Beta
Coefficient
-1.386 *
Beta
Coefficient
-1.372
95% C.I.
Protein †
0.014
-2.591, -0.181
*
-0.006, 0.034
0.016
-0.009, 0.041
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.001 *
0.001, 0.003 *
0.001
-0.0001, 0.002
-0.009
-0.054, 0.036
-0.017
-0.076, 0.042
Body mass index, kg/m2
0.036 *
0.001, 0.071 *
0.041
-0.0001, 0.081
Age, years
-0.004
-0.016, 0.008
% male §
0.007
-0.146, 0.160
Carbohydrates, % of
energy intake ¶
0.002
-0.006, 0.010
-2.781, 0.037
47
48
Models for mean difference in Triglycerides. (N=1,897 participants; 24 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
0.194
Protein †
Full Adjusted Model
95% C.I.
-0.939, 1.327
Beta
Coefficient
0.319
0.009
-0.020, 0.038
0.021
-0.012, 0.054
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.0001
-0.001, 0.001
0.0004
-0.001, 0.001
0.023
-0.067, 0.113
0.012
-0.086, 0.110
Body mass index, kg/m2
-0.016
-0.049, 0.017
-0.014
-0.047, 0.019
Age, years
-0.0008
-0.013, 0.011
% male §
-0.078
-0.286, 0.130
Carbohydrates, % of
energy intake ¶
0.007
-0.003, 0.017
-0.896, 1.534
Models for mean difference in C-reactive protein. (N=398 participants; 6 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
1.759
Protein †
Duration of diet
intervention, days
Energy, 100 kcals ‡
Full Adjusted Model
95% C.I.
-3.431, 6.950
Beta
Coefficient
-31.0
-0.171
-0.675, 0.333
0.363
-0.424, 1.151
-0.0002
-0.008, 0.008
-0.028
-0.067, 0.010
0.547
-1.332, 2.426
3.522
-1.034, 8.078
Age, years
0.347
-0.139, 0.832
% male §
9.889
-3.042,
22.820
-74.6, -12.5
2
Body mass index, kg/m ††
Carbohydrates, % of
energy intake ¶ ‡‡
†† BMI is not included in any of the models since BMI is not an a priori predictor of CRP.
‡‡ Carbohydrate intake is not included in any of the models due to colinearity with trial duration (R=-0.95).
48
49
Models for mean difference in fasting blood glucose. (N=1,433 participants; 17 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
0.393
Protein †
Full Adjusted Model
95% C.I.
-0.575, 1.361
Beta
Coefficient
0.058
0.018
-0.004, 0.040
0.014
-0.006, 0.034
Duration of diet
intervention, days
Energy, 100 kcals ‡
0.0005
-0.0001, 0.001
0.0011 *
0.0001, 0.002 *
0.012
-0.059, 0.083
0.025
-0.046, 0.096
Body mass index, kg/m2
-0.019
-0.050, 0.012
-0.0095
-0.045, 0.026
Age, years
-0.001
-0.011, 0.009
% male §
-0.211 *
-0.419, -0.003 *
Carbohydrates, % of
energy intake ¶
0.007
-0.005, 0.019
-0.891, 1.007
Models for mean difference in fasting serum insulin. (N=1,002 participants; 10 studies)
Primary Model
95% C.I.
Intercept
Beta
Coefficient
48.4
Protein †
Duration of diet
intervention, days
Energy, 100 kcals ‡
Full Adjusted Model
95% C.I.
-121.0, 217.8
Beta
Coefficient
315.5
3.114
-2.785, 9.013
-2.274
-15.7, 11.1
-0.004
-0.086, 0.078
0.021
-0.226, 0.268
-1.502
-12.164, 9.160
3.695
-15.533, 22.923
-2.644
-7.434, 2.146
-6.657
-17.351, 4.037
Age, years
-0.170
-4.431, 4.092
% male §
-40.47
-137.8, 56.9
Carbohydrates, % of
energy intake ¶
1.015
-4.190, 6.220
Body mass index, kg/m
2
-106.7, 737.7
49
50
Supplement 6: Meta-analyses of all health outcomes for end of study scores (secondary
analysis)
(SD: Standard deviation; IV: inverse variance method; Std: Standard, CI: confidence intervals)
Weight
Study or Subgroup
7.2.1 at 1 month
Appel 2005
Baba 1999
Farnsworth 2003
Farnsworth 2003
Johnston 2004
Lean 1997
Luscombe-Marsh 2005men
Luscombe-Marsh 2005women
Mamo 2005
Nickols-Richardson 2005
Wolfe 1991
Wolfe 1992
Wolfe 1999
Subtotal (95% CI)
Higher protein diets
Mean
SD
Total
86
104.9
102.7
86.4
78.28
82
95.1
86.6
88.7
78.2
62.4
78
65
18.2
16.9
13.8
10.1
27.4
14.6
10.4
10.8
3.6
15.9
18.7
2
12.6
80
7
7
21
9
53
12
15
10
13
5
3
5
132
Lower protein diets
Mean
SD
Total
Weight
Std. Mean Difference
IV, Random, 95% CI
86.3
99.5
104
84.7
81.2
81.7
106
86
93.3
75.6
66.2
87
65
18.2
12.2
12.7
10.1
18.6
16.6
14.1
9.5
5.5
15.4
15.1
21.2
15.8
81
6
7
21
7
57
13
17
10
15
5
2
5
131
8.4%
0.7%
0.0%
0.0%
0.8%
0.0%
0.0%
0.0%
0.9%
1.4%
0.5%
0.2%
0.5%
13.5%
-0.02 [-0.33, 0.29]
0.34 [-0.77, 1.44]
-0.09 [-1.14, 0.96]
0.17 [-0.44, 0.77]
-0.11 [-1.10, 0.87]
0.02 [-0.35, 0.39]
-0.85 [-1.67, -0.02]
0.06 [-0.64, 0.75]
-0.95 [-1.88, -0.01]
0.16 [-0.58, 0.91]
-0.20 [-1.45, 1.04]
-0.53 [-2.46, 1.40]
0.00 [-1.24, 1.24]
-0.06 [-0.31, 0.18]
86
90.7
78.8
88.8
101
82.7
80
90.5
103
83.7
70.3
93.7
85.5
85
62.6
88.5
6.3246
13.8
8.22
17.1
11.1
10.5
15.3
20.64
14.1
9.9
9
14.5
12
11.8
9.9
14.9
20
47
10
96
7
21
31
7
13
17
14
31
16
21
9
37
292
2.1%
0.0%
1.0%
10.1%
0.0%
0.0%
3.1%
0.8%
0.0%
0.0%
1.4%
3.1%
1.6%
2.3%
0.9%
3.8%
30.3%
-0.25 [-0.88, 0.37]
-0.27 [-0.66, 0.13]
0.07 [-0.80, 0.95]
-0.05 [-0.33, 0.24]
-0.19 [-1.24, 0.86]
0.16 [-0.44, 0.77]
0.10 [-0.41, 0.61]
0.68 [-0.34, 1.71]
-0.86 [-1.69, -0.04]
0.08 [-0.61, 0.78]
0.43 [-0.32, 1.18]
-0.41 [-0.92, 0.09]
-0.10 [-0.80, 0.61]
-0.44 [-1.03, 0.15]
0.04 [-0.89, 0.96]
-0.21 [-0.67, 0.24]
-0.09 [-0.25, 0.07]
78.5
83.5
92
88.5
91.1
87.5
92.9
99
81.1
73.1
85.9
80.2
74.5
101
82.3
76.9
76.6
89.2
11.9262
13.5
12.9615
8.9443
18
10.1
29.1
10.8
10.5
9.7
12.1
16.6
10.5
15.9
9.9
7.5
15
13.9
18
29
42
20
43
66
4
7
21
12
12
57
25
13
17
8
11
20
348
1.9%
3.1%
3.9%
0.0%
4.7%
6.1%
0.5%
0.7%
2.2%
1.2%
1.2%
0.0%
2.4%
1.2%
1.7%
0.9%
1.3%
2.1%
35.0%
0.14 [-0.51, 0.79]
-0.09 [-0.60, 0.42]
0.23 [-0.23, 0.68]
-0.53 [-1.15, 0.08]
-0.20 [-0.62, 0.21]
0.19 [-0.17, 0.56]
-0.30 [-1.57, 0.98]
-0.25 [-1.30, 0.80]
0.13 [-0.48, 0.73]
0.26 [-0.54, 1.07]
-0.25 [-1.05, 0.56]
-0.01 [-0.39, 0.36]
0.00 [-0.58, 0.58]
-0.77 [-1.59, 0.05]
0.10 [-0.59, 0.79]
0.21 [-0.72, 1.14]
0.18 [-0.61, 0.98]
-0.21 [-0.83, 0.41]
0.01 [-0.14, 0.16]
89
74.7
79.6
93.31
88.5
11.1803
13
16.6
20.59
15
20
8
57
27
37
149
2.1%
0.8%
5.7%
2.9%
3.6%
15.1%
-0.51 [-1.13, 0.10]
-0.40 [-1.43, 0.63]
-0.02 [-0.39, 0.36]
-0.05 [-0.58, 0.48]
-0.40 [-0.87, 0.07]
-0.20 [-0.44, 0.03]
83
89.5
18
16.4
36
38
74
3.6%
2.6%
6.1%
-0.20 [-0.67, 0.28]
0.08 [-0.48, 0.64]
-0.08 [-0.44, 0.28]
994
100.0%
-0.07 [-0.16, 0.02]
Std. Mean Difference
IV, Random, 95% CI
Heterogeneity: Tau² = 0.00; Chi² = 4.67, df = 7 (P = 0.70); I² = 0%
Test for overall effect: Z = 0.51 (P = 0.61)
7.2.3 at 2 months
Brehm 2005
Brinkworth 2009
Buscemi 2009
de Luis 2009a
Farnsworth 2003
Farnsworth 2003
Hodgson 2006
Kleiner 2006
Luscombe-Marsh 2005men
Luscombe-Marsh 2005women
Mahon 2007
McAuley 2005
Meckling 2004
Noakes 2006
Sacks 1984
Te Morenga 2011
Subtotal (95% CI)
84
87
79.6
88
98.5
84.4
81.5
102.2
91.6
84.6
74.4
87.8
84
80
63
85.3
8.9443
13.9
12.02
17.6
13
10.1
14.3
11.7
11.1
11.2
9.6
13.7
17.04
10.6
10.2
14.7
20
52
10
97
7
21
29
9
12
15
14
30
15
24
9
37
294
Heterogeneity: Tau² = 0.00; Chi² = 8.30, df = 10 (P = 0.60); I² = 0%
Test for overall effect: Z = 1.07 (P = 0.28)
7.2.5 at 3 months
Ballesteros-Pomar 2010
Barnard 2004
Belobrajdic 2010
Brehm 2003
de Luis 2007
de Luis 2009b
Dyson 2007
Farnsworth 2003
Farnsworth 2003
Layman 2005
Layman 2005
Lean 1997
Leidy 2007
Luscombe-Marsh 2005men
Luscombe-Marsh 2005women
Meckling 2007
Meckling 2007
Volek 2009
Subtotal (95% CI)
80.3
82.3
95
83.5
87.7
90.4
85.3
96
82.5
76.3
82.4
80
74.5
90
83.4
79.5
79.2
86.4
13.2423
12
13.4112
9.3808
15.3
19.7
18.8
11.6
10.8
13.5
15.2
14.6
15.12
11.1
11.6
14.2
12.4
12
18
30
34
22
47
52
6
7
21
12
12
53
21
12
15
10
14
20
331
Heterogeneity: Tau² = 0.00; Chi² = 8.91, df = 15 (P = 0.88); I² = 0%
Test for overall effect: Z = 0.10 (P = 0.92)
7.2.7 at 6 months
Brehm 2003
Ferrara 2006
Lean 1997
Lopez-Jimenez 2010
Morgan 2009
Subtotal (95% CI)
83
70
79.3
92.21
83.2
11.726
8
15.3
20.43
10.6
22
7
53
28
33
143
Heterogeneity: Tau² = 0.00; Chi² = 3.02, df = 4 (P = 0.55); I² = 0%
Test for overall effect: Z = 1.73 (P = 0.08)
7.2.9 more than 6 months
Brinkworth 2009
Fleming 2002
Subtotal (95% CI)
79.5
90.9
17.2337
17.3
33
18
51
Heterogeneity: Tau² = 0.00; Chi² = 0.55, df = 1 (P = 0.46); I² = 0%
Test for overall effect: Z = 0.43 (P = 0.66)
Total (95% CI)
951
Heterogeneity: Tau² = 0.00; Chi² = 27.83, df = 41 (P = 0.94); I² = 0%
Test for overall effect: Z = 1.50 (P = 0.13)
Test for subgroup differences: Chi² = 2.37, df = 4 (P = 0.67), I² = 0%
-2
-1
Favours higher protein
0
1
2
Favours lower protein
50
51
Body Mass Index
Study or Subgroup
7.4.1 at 1 month
Baba 1999
Mamo 2005
Nickols-Richardson 2005
Subtotal (95% CI)
Higher protein diets Lower protein diets
Std. Mean Difference
Mean
SD Total Mean
SD Total Weight IV, Random, 95% CI
34.1
31.2
29.3
4.8
1.2
4.6
7
10
13
30
32.6
31.6
29
2
1.6
5.3
Std. Mean Difference
IV, Random, 95% CI
6
10
15
31
1.0%
1.6%
2.2%
4.7%
0.37 [-0.74, 1.47]
-0.27 [-1.15, 0.61]
0.06 [-0.68, 0.80]
0.02 [-0.49, 0.52]
10
47
96
14
31
16
37
204
1.5%
0.0%
15.1%
2.1%
4.6%
2.4%
5.8%
31.5%
0.10 [-0.80, 1.00]
-0.18 [-0.57, 0.22]
0.13 [-0.15, 0.42]
0.38 [-0.37, 1.13]
-0.53 [-1.04, -0.02]
0.02 [-0.69, 0.72]
-0.26 [-0.72, 0.20]
-0.05 [-0.31, 0.21]
18
29
42
43
66
4
18
25
8
11
31
35
20
350
2.8%
4.6%
5.8%
7.0%
9.1%
0.7%
2.8%
3.6%
1.3%
1.9%
4.6%
5.6%
3.0%
52.9%
-0.07 [-0.72, 0.58]
-0.07 [-0.58, 0.44]
0.35 [-0.11, 0.80]
-0.05 [-0.47, 0.36]
-0.06 [-0.42, 0.30]
-0.42 [-1.70, 0.87]
0.33 [-0.33, 0.98]
0.17 [-0.42, 0.75]
0.55 [-0.40, 1.50]
0.10 [-0.69, 0.89]
-0.13 [-0.64, 0.38]
-0.12 [-0.58, 0.35]
-0.49 [-1.12, 0.14]
-0.00 [-0.15, 0.15]
43
8
27
35
0.0%
1.2%
4.3%
5.4%
-0.19 [-0.61, 0.23]
-0.04 [-1.06, 0.97]
-0.25 [-0.79, 0.28]
-0.21 [-0.68, 0.26]
36
5.4%
-0.20 [-0.68, 0.27]
36
5.4%
-0.20 [-0.68, 0.27]
Heterogeneity: Tau² = 0.00; Chi² = 0.81, df = 2 (P = 0.67); I² = 0%
Test for overall effect: Z = 0.06 (P = 0.95)
7.4.3 at 2 months
Abete 2009
Brinkworth 2009
de Luis 2009a
Mahon 2007
McAuley 2005
Meckling 2004
Te Morenga 2011
Subtotal (95% CI)
30.1
30.9
34.5
27.6
32.4
30.1
31.3
1.9
3.8
7.3
3.4
4.8
6.2
4.5
9
52
97
14
30
15
37
202
29.8
31.6
33.6
26.3
35.2
30
32.5
3.4
4
5.9
3.2
5.6
3.6
4.7
Heterogeneity: Tau² = 0.03; Chi² = 7.19, df = 5 (P = 0.21); I² = 31%
Test for overall effect: Z = 0.40 (P = 0.69)
7.4.5 at 3 months
Ballesteros-Pomar 2010 29.4556 2.9246
Barnard 2004
31.2
3.5
Belobrajdic 2010
30.4 3.4986
de Luis 2007
34.1
5.6
de Luis 2009b
33.9
6.6
Dyson 2007
31.5
7.4
Iglay 2007
26.8 3.81
Leidy 2007
27.7 4.12
Meckling 2007
29.5
4.1
Meckling 2007
28.8
4.9
Thorpe 2008
29.1
3.6
Thorpe 2008
29.7
4.5
Volek 2009
30
4.3
Subtotal (95% CI)
18 29.6611 2.7789
30
31.5
5.3
34
29.1 3.8884
47
34.4
5.9
52
34.3
6.9
6
36.2 13.6
18
25.6 3.39
21
27.1
3
10
27.6
1.7
14
28.3
4.4
28
29.6
3.9
36
30.2
3.8
20
32.1
4.1
334
Heterogeneity: Tau² = 0.00; Chi² = 8.32, df = 12 (P = 0.76); I² = 0%
Test for overall effect: Z = 0.00 (P = 1.00)
7.4.7 at 6 months
Brinkworth 2009
Ferrara 2006
Lopez-Jimenez 2010
Subtotal (95% CI)
28.9
22.8
31.88
3.4
2.4
6.65
45
7
28
35
29.6
22.9
33.48
3.9
1.9
5.67
Heterogeneity: Tau² = 0.00; Chi² = 0.13, df = 1 (P = 0.72); I² = 0%
Test for overall effect: Z = 0.87 (P = 0.38)
7.4.9 more than 6 months
Brinkworth 2009
28.4
3.45
Subtotal (95% CI)
33
29.2
4.2
33
Heterogeneity: Not applicable
Test for overall effect: Z = 0.85 (P = 0.40)
Total (95% CI)
634
656 100.0%
Heterogeneity: Tau² = 0.00; Chi² = 17.72, df = 24 (P = 0.82); I² = 0%
Test for overall effect: Z = 0.55 (P = 0.59)
Test for subgroup differences: Chi² = 1.28, df = 4 (P = 0.86), I² = 0%
-0.03 [-0.14, 0.08]
-2
-1
Favours higher
0
1
Favours lower
2
51
52
Waist circumference
Higher protein
Lower protein diets
Std. Mean Difference
Study or Subgroup Mean
SD Total Mean
SD Total Weight IV, Random, 95% CI
7.26.1 at 1 month
Subtotal (95% CI)
0
0
Not estimable
Heterogeneity: Not applicable
Test for overall effect: Not applicable
7.26.3 at 2 months
Abete 2009
97.6
6.6
9
98
6.5
10 3.8%
Buscemi 2009
94 15.81
10
97 6.32
10 3.9%
de Luis 2009a
102.5
14
97 103.1 15.5
96 20.6%
McAuley 2005
100.3 9.6
30
104 10.9
31 9.9%
Te Morenga 2011
88.3 10.4
37
92.5 11.4
37 11.4%
Subtotal (95% CI)
183
184 49.6%
Heterogeneity: Tau² = 0.00; Chi² = 2.21, df = 4 (P = 0.70); I² = 0%
Test for overall effect: Z = 1.64 (P = 0.10)
7.26.5 at 3 months
Ballesteros-Pomar 201098.3 9.3517 18 95.43898.3509
de Luis 2007
103.9 14.8
47
105 15.5
de Luis 2009b
105.8 13.4
52
100 13.9
Iglay 2007
83.5 11.6
16
83.5 12.4
Subtotal (95% CI)
133
18 6.5%
43 13.2%
66 15.4%
17 6.1%
144 41.2%
Std. Mean Difference
IV, Random, 95% CI
-0.06 [-0.96, 0.84]
-0.24 [-1.12, 0.64]
-0.04 [-0.32, 0.24]
-0.36 [-0.86, 0.15]
-0.38 [-0.84, 0.08]
-0.17 [-0.38, 0.03]
0.32 [-0.34, 0.97]
-0.07 [-0.49, 0.34]
0.42 [0.05, 0.79]
0.00 [-0.68, 0.68]
0.19 [-0.08, 0.45]
Heterogeneity: Tau² = 0.01; Chi² = 3.50, df = 3 (P = 0.32); I² = 14%
Test for overall effect: Z = 1.40 (P = 0.16)
7.26.7 at 6 months
Lopez-Jimenez 2010 101.6 14.04
Subtotal (95% CI)
28 106.33 13.46
28
27
27
9.2%
9.2%
-0.34 [-0.87, 0.19]
-0.34 [-0.87, 0.19]
Heterogeneity: Not applicable
Test for overall effect: Z = 1.25 (P = 0.21)
7.26.9 more than 6 months
Subtotal (95% CI)
Heterogeneity: Not applicable
Test for overall effect: Not applicable
Total (95% CI)
0
344
0
355 100.0%
Heterogeneity: Tau² = 0.02; Chi² = 12.21, df = 9 (P = 0.20); I² = 26%
Test for overall effect: Z = 0.57 (P = 0.57)
Test for subgroup differences: Chi² = 5.61, df = 2 (P = 0.06), I² = 64.3%
Not estimable
-0.05 [-0.24, 0.13]
-1
-0.5 0
0.5
1
Favours higher
Favours lower
52
53
Systolic blood pressure
Higher protein
Lower protein diets
Std. Mean Difference
Study or Subgroup Mean
SD Total Mean
SD Total Weight IV, Random, 95% CI
7.6.1 at 1 month
Jenkins 2001
Keogh 2007
Subtotal (95% CI)
117
110
9.5
14.4
10
13
10
118
115
9.5
13.9
10
12
10
2.3%
0.0%
2.3%
-0.10 [-0.98, 0.78]
-0.34 [-1.13, 0.45]
-0.10 [-0.98, 0.78]
10 2.2%
20 4.2%
47 0.0%
10 2.0%
96 11.9%
31 5.5%
7 1.8%
30 5.7%
16 3.3%
20 4.1%
9 2.1%
37 6.7%
286 49.5%
0.07 [-0.83, 0.97]
-0.13 [-0.75, 0.49]
-0.09 [-0.49, 0.31]
-0.95 [-1.89, -0.01]
-0.13 [-0.41, 0.15]
-0.66 [-1.18, -0.14]
-0.57 [-1.58, 0.44]
0.00 [-0.51, 0.51]
0.56 [-0.16, 1.28]
-0.11 [-0.73, 0.52]
0.06 [-0.87, 0.98]
-0.07 [-0.53, 0.39]
-0.15 [-0.34, 0.04]
Std. Mean Difference
IV, Random, 95% CI
Heterogeneity: Not applicable
Test for overall effect: Z = 0.23 (P = 0.82)
7.6.3 at 2 months
Abete 2009
Brehm 2005
Brinkworth 2009
Buscemi 2009
de Luis 2009a
Hodgson 2006
Kleiner 2006
McAuley 2005
Meckling 2004
Rouse 1986
Sacks 1984
Te Morenga 2011
Subtotal (95% CI)
115
114
122
117
122.8
131.8
114
122
114.6
118.7
108.8
121
3.1
17
12
9.49
26.6
12.8
6
14
6.97
13.6
13.5
15
9 114.5
8.6
20
116 12.5
51
123
10
10
125 6.32
97 125.5 12.8
29
140 11.9
9
119 10.58
29
122
13
15
110
8.8
19
120 10.3
9
108 13.7
37
122
13
283
Heterogeneity: Tau² = 0.02; Chi² = 11.77, df = 10 (P = 0.30); I² = 15%
Test for overall effect: Z = 1.54 (P = 0.12)
7.6.5 at 3 months
Brehm 2003
de Luis 2009b
Keogh 2007
Leidy 2007
Meckling 2007
Meckling 2007
Subtotal (95% CI)
112
124
111
104
127
119
11.1
13
14.4
9.17
17
13
22
52
13
21
14
10
97
116
126
118
110
122
118
9
16
17.3
45
10
12
20 0.0%
66 9.1%
12 0.0%
25 4.7%
11 2.7%
8 2.1%
110 18.5%
-0.39 [-1.00, 0.23]
-0.13 [-0.50, 0.23]
-0.43 [-1.22, 0.37]
-0.17 [-0.76, 0.41]
0.34 [-0.46, 1.13]
0.08 [-0.85, 1.01]
-0.07 [-0.34, 0.21]
Heterogeneity: Tau² = 0.00; Chi² = 1.34, df = 3 (P = 0.72); I² = 0%
Test for overall effect: Z = 0.49 (P = 0.62)
7.6.7 at 6 months
Brehm 2003
114 13.23
Brinkworth 2009
120.8 11.5
Ferrara 2006
111.6
5
Sacks 2009
119
12
Subtotal (95% CI)
22
45
7
201
230
113 10.78
125 15.8
113
9
116
12
20 4.4%
43 0.0%
8 1.8%
201 15.9%
229 22.0%
0.08 [-0.52, 0.69]
-0.30 [-0.72, 0.12]
-0.18 [-1.19, 0.84]
0.25 [0.05, 0.45]
0.22 [0.04, 0.40]
Heterogeneity: Tau² = 0.00; Chi² = 0.88, df = 2 (P = 0.65); I² = 0%
Test for overall effect: Z = 2.35 (P = 0.02)
7.6.9 more than 6 months
Brinkworth 2009
118.9 11.49
Keogh 2007
115 14.1
Subtotal (95% CI)
33
8
41
121
130
17.4
8.9
36
5
41
6.4%
1.2%
7.6%
-0.14 [-0.61, 0.33]
-1.12 [-2.35, 0.11]
-0.46 [-1.36, 0.44]
Heterogeneity: Tau² = 0.25; Chi² = 2.12, df = 1 (P = 0.15); I² = 53%
Test for overall effect: Z = 1.00 (P = 0.32)
Total (95% CI)
661
676 100.0%
Heterogeneity: Tau² = 0.02; Chi² = 26.29, df = 20 (P = 0.16); I² = 24%
Test for overall effect: Z = 0.96 (P = 0.33)
Test for subgroup differences: Chi² = 9.16, df = 4 (P = 0.06), I² = 56.3%
-0.07 [-0.21, 0.07]
-2
-1
Favours higher
0
1
Favours lower
2
53
54
Diastolic blood pressure
Study
7.8.1 at 1 month
Jenkins 2001
Keogh 2007
Subtotal (95% CI)
Higher protein
Lower protein diets
Std. Mean Difference
Mean
SD Total Mean
SD Total Weight IV, Random, 95% CI
76
68
6.3
7.2
10
13
10
77
72
6.3
3.5
72.5
74
70
84
81.9
77.9
69
80
72.9
73.2
71.3
79
8.5
8.9
9
6.32
7.7
7.4
7.94
9
10
10.7
8.6
10
10
12
10
1.8%
0.0%
1.8%
-0.15 [-1.03, 0.73]
-0.67 [-1.48, 0.14]
-0.15 [-1.03, 0.73]
10 1.6%
20 3.6%
47 0.0%
10 1.8%
96 13.8%
31 5.2%
7 1.5%
30 5.0%
16 2.8%
20 3.5%
9 1.7%
37 6.1%
286 46.5%
0.69 [-0.24, 1.62]
-0.10 [-0.72, 0.52]
-0.26 [-0.66, 0.13]
0.12 [-0.76, 1.00]
-0.14 [-0.42, 0.14]
-0.04 [-0.54, 0.47]
0.00 [-0.99, 0.99]
-0.49 [-1.01, 0.03]
-0.11 [-0.82, 0.59]
-0.24 [-0.87, 0.39]
0.06 [-0.86, 0.99]
-0.44 [-0.90, 0.02]
-0.16 [-0.32, 0.01]
Std. Mean Difference
IV, Random, 95% CI
Heterogeneity: Not applicable
Test for overall effect: Z = 0.34 (P = 0.73)
7.8.3 at 2 months
Abete 2009
Brehm 2005
Brinkworth 2009
Buscemi 2009
de Luis 2009a
Hodgson 2006
Kleiner 2006
McAuley 2005
Meckling 2004
Rouse 1986
Sacks 1984
Te Morenga 2011
Subtotal (95% CI)
78.3
7.5
73 10.7
67
13
85 9.49
80 17.7
77.6
9
69
9
76
7
71.6 12.39
70.9
8.2
71.9
9.3
75
8
9
20
51
10
97
29
9
29
15
19
9
37
283
Heterogeneity: Tau² = 0.00; Chi² = 7.18, df = 10 (P = 0.71); I² = 0%
Test for overall effect: Z = 1.88 (P = 0.06)
7.8.5 at 3 months
Brehm 2003
de Luis 2009b
Keogh 2007
Leidy 2007
Meckling 2007
Meckling 2007
Subtotal (95% CI)
72
81.1
67
66
78
72
9.7
7.4
7.2
4.58
10
7
22
52
13
21
14
10
97
75
79.2
70
65
77
75
8
12.8
6.9
10
9
14
20 0.0%
66 9.2%
12 0.0%
25 4.0%
11 2.3%
8 1.6%
110 17.1%
-0.33 [-0.94, 0.28]
0.18 [-0.19, 0.54]
-0.41 [-1.21, 0.38]
0.12 [-0.46, 0.70]
0.10 [-0.69, 0.89]
-0.27 [-1.20, 0.67]
0.12 [-0.16, 0.39]
Heterogeneity: Tau² = 0.00; Chi² = 0.75, df = 3 (P = 0.86); I² = 0%
Test for overall effect: Z = 0.83 (P = 0.41)
7.8.7 at 6 months
Brehm 2003
Brinkworth 2009
Ferrara 2006
Sacks 2009
Subtotal (95% CI)
74 10.46
69 11.7
70
7
119
12
22
45
7
201
230
74
72.3
73.1
116
7.24
9.01
7
12
20 3.7%
43 0.0%
8 1.4%
201 22.5%
229 27.6%
0.00 [-0.61, 0.61]
-0.31 [-0.73, 0.11]
-0.42 [-1.45, 0.61]
0.25 [0.05, 0.45]
0.20 [0.00, 0.40]
Heterogeneity: Tau² = 0.00; Chi² = 2.04, df = 2 (P = 0.36); I² = 2%
Test for overall effect: Z = 2.00 (P = 0.05)
7.8.9 more than 6 months
Brinkworth 2009
Keogh 2007
Subtotal (95% CI)
66 11.49
68
8.5
33
8
41
69.2
74
10.2
6.7
36
5
41
5.8%
1.1%
6.9%
-0.29 [-0.77, 0.18]
-0.71 [-1.87, 0.46]
-0.35 [-0.79, 0.09]
Heterogeneity: Tau² = 0.00; Chi² = 0.42, df = 1 (P = 0.52); I² = 0%
Test for overall effect: Z = 1.57 (P = 0.12)
Total (95% CI)
661
676 100.0%
Heterogeneity: Tau² = 0.01; Chi² = 21.98, df = 20 (P = 0.34); I² = 9%
Test for overall effect: Z = 0.49 (P = 0.63)
Test for subgroup differences: Chi² = 10.73, df = 4 (P = 0.03), I² = 62.7%
-0.03 [-0.15, 0.09]
-1 -0.5
Favours higher
0
0.5 1
Favours lower
54
55
Total cholesterol
Higher protein
Lower protein diets
Std. Mean Difference
Study or Subgroup
Mean
SD Total Mean
SD Total Weight
IV, Random, 95% CI
7.10.1 at 1 month
Baba 1999
3.37
0.81
7
3.48
0.82
6
1.5%
-0.13 [-1.22, 0.97]
Farnsworth 2003
4.66
0.5
7
4.39
10.1
7
0.0%
0.04 [-1.01, 1.08]
Farnsworth 2003
4.84
1.1
21
5.34
1
21
0.0%
-0.47 [-1.08, 0.15]
Jenkins 2001
5.85
0.7
10
6.06
0.7
10
2.0%
-0.29 [-1.17, 0.59]
Johnston 2004
4.52
0.7
9
4.36
0.4
7
1.7%
0.26 [-0.74, 1.25]
Keogh 2007
4.52
3
13
4.78
4.8
12
0.0%
-0.06 [-0.85, 0.72]
Mamo 2005
5.1
0.2
10
5.7
0.4
10
1.5%
-1.82 [-2.90, -0.74]
Volek 2003
5.34
0.89
5
4.35
0.88
5
1.1%
1.01 [-0.35, 2.37]
Wolfe 1991
5.34
0.85
5
6.5
0.58
5
0.9%
-1.44 [-2.92, 0.04]
Wolfe 1992
7.1
1.4
3
7.8
0.3
2
0.6%
-0.44 [-2.33, 1.44]
Wolfe 1999
3.8
0.6
5
4.1
0.3
5
1.2%
-0.57 [-1.85, 0.71]
Subtotal (95% CI)
54
50 10.4%
-0.42 [-1.03, 0.20]
Heterogeneity: Tau² = 0.40; Chi² = 14.69, df = 7 (P = 0.04); I² = 52%
Test for overall effect: Z = 1.32 (P = 0.19)
7.10.3 at 2 months
Abete 2009
4.31
1.01
9
4.47
0.68
10
Brehm 2005
5.01
0.82
20
4.67
1.01
20
Brinkworth 2009
5.1
1.2
52
4.8
0.7
47
Buscemi 2009
4.71
0.98
10
5.15
1.23
10
de Luis 2009a
4.82
1.02
97
5.11
0.86
96
Farnsworth 2003
4.91
0.9
21
5.26
0.9
21
Farnsworth 2003
4.7
0.6
7
4.59
0.9
7
Hodgson 2006
4.9
0.8
29
4.9
0.8
31
Kleiner 2006
5.36
0.62
9
4.62
0.66
7
Mahon 2007
5.64
1.37
14
6.21
1.09
14
McAuley 2005
5
0.8
30
5.3
0.9
31
Meckling 2004
6
1.1
15
4.29
1.03
16
Noakes 2006
5.68
1.4
24
5.27
1.2
21
Stoernell 2008
4.47
0.45
10
4.73
1.19
13
Te Morenga 2011
4.7
0.9
37
4.7
0.7
37
Subtotal (95% CI)
304
306
Heterogeneity: Tau² = 0.14; Chi² = 28.84, df = 11 (P = 0.002); I² = 62%
Test for overall effect: Z = 0.39 (P = 0.69)
1.9%
2.8%
0.0%
2.0%
4.4%
0.0%
0.0%
3.3%
1.5%
2.4%
3.3%
2.1%
3.0%
2.1%
3.6%
32.3%
-0.18 [-1.08, 0.72]
0.36 [-0.26, 0.99]
0.30 [-0.10, 0.70]
-0.38 [-1.27, 0.51]
-0.31 [-0.59, -0.02]
-0.38 [-0.99, 0.23]
0.13 [-0.91, 1.18]
0.00 [-0.51, 0.51]
1.10 [0.02, 2.18]
-0.45 [-1.20, 0.30]
-0.35 [-0.85, 0.16]
1.56 [0.75, 2.38]
0.31 [-0.28, 0.90]
-0.26 [-1.09, 0.56]
0.00 [-0.46, 0.46]
0.06 [-0.23, 0.34]
2.7%
0.0%
4.0%
1.2%
0.0%
0.0%
2.7%
3.3%
0.0%
2.2%
2.2%
2.9%
3.2%
2.0%
1.7%
2.3%
3.9%
2.8%
37.1%
-0.46 [-1.13, 0.20]
0.35 [-0.26, 0.96]
0.27 [-0.10, 0.63]
0.24 [-1.03, 1.51]
-0.36 [-0.97, 0.25]
0.15 [-0.90, 1.20]
0.29 [-0.37, 0.96]
0.00 [-0.51, 0.51]
-0.06 [-0.85, 0.72]
0.47 [-0.34, 1.28]
0.23 [-0.57, 1.04]
-0.73 [-1.33, -0.12]
0.28 [-0.25, 0.81]
1.06 [0.21, 1.91]
-0.82 [-1.79, 0.16]
-0.88 [-1.66, -0.09]
-0.26 [-0.66, 0.13]
0.06 [-0.56, 0.67]
-0.02 [-0.27, 0.23]
20
43
23
8
27
201
279
2.8%
0.0%
3.0%
1.6%
3.2%
4.7%
15.3%
0.74 [0.11, 1.36]
0.50 [0.07, 0.92]
-0.46 [-1.05, 0.12]
-0.32 [-1.34, 0.71]
0.24 [-0.29, 0.77]
0.31 [0.12, 0.51]
0.17 [-0.19, 0.53]
36
5
41
3.5%
1.4%
4.9%
0.42 [-0.06, 0.90]
-0.34 [-1.47, 0.79]
0.22 [-0.45, 0.88]
Total (95% CI)
985
991 100.0%
Heterogeneity: Tau² = 0.13; Chi² = 96.76, df = 40 (P < 0.00001); I² = 59%
Test for overall effect: Z = 0.00 (P = 1.00)
Test for subgroup differences: Chi² = 3.11, df = 4 (P = 0.54), I² = 0%
0.00 [-0.16, 0.16]
7.10.5 at 3 months
Ballesteros-Pomar 2010
4.45
1.11
18
4.94
0.95
18
Brehm 2003
4.8
0.68
22
4.56
0.68
20
de Luis 2009b
5.04
0.8
52
4.77
1.14
66
Dyson 2007
5.7
1.2
6
5.4
1
4
Farnsworth 2003
4.92
1
21
5.31
1.1
21
Farnsworth 2003
4.69
0.69
7
4.55
1
7
Iglay 2007
4.97
0.88
18
4.71
0.85
17
Josse 2011a
4.39
0.13
30
4.39
0.11
30
Keogh 2007
4.59
3.1
13
4.82
3.8
12
Layman 2005
5.35
1
12
4.91
0.8
12
Layman 2005
4.8
0.8
12
4.63
0.6
12
Leidy 2007
4.09
0.59
21
4.55
0.65
25
Luscombe-Marsh 2005
5.2
1.1
26
4.9
1
30
Meckling 2007
4.5
0.8
14
3.28
1.42
11
Meckling 2007
3.13
1.09
10
6.36
5.56
8
Moran 2003
4.87
0.9
14
5.56
0.6
14
Noakes 2005
5.26
1.1
52
5.54
1
48
Volek 2009
5.08
0.9
20
5.03
0.88
20
Subtotal (95% CI)
305
315
Heterogeneity: Tau² = 0.11; Chi² = 28.29, df = 13 (P = 0.008); I² = 54%
Test for overall effect: Z = 0.18 (P = 0.85)
7.10.7 at 6 months
Brehm 2003
5.31
0.82
22
4.73
0.72
Brinkworth 2009
5.37
1.19
45
4.85
0.84
Due 2004
4.6
0.8
23
5
0.9
Ferrara 2006
3.23
1.1
7
3.57
0.92
Lopez-Jimenez 2010
4.88
0.74
28
4.71
0.65
Sacks 2009
5.15
0.91
201
4.86
0.93
Subtotal (95% CI)
281
Heterogeneity: Tau² = 0.09; Chi² = 9.55, df = 4 (P = 0.05); I² = 58%
Test for overall effect: Z = 0.92 (P = 0.36)
7.10.9 more than 6 months
Brinkworth 2009
6
1.15
33
5.5
1.2
Keogh 2007
4.62
0.7
8
4.94
1.1
Subtotal (95% CI)
41
Heterogeneity: Tau² = 0.10; Chi² = 1.49, df = 1 (P = 0.22); I² = 33%
Test for overall effect: Z = 0.64 (P = 0.52)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
0
1
2
Favours higher protein Favours lower protein
55
56
HDL cholesterol
Higher protein
Lower protein diets
Std. Mean Difference
Study or Subgroup
Mean
SD Total Mean
SD Total Weight
IV, Random, 95% CI
7.10.1 at 1 month
Baba 1999
3.37
0.81
7
3.48
0.82
6
1.5%
-0.13 [-1.22, 0.97]
Farnsworth 2003
4.66
0.5
7
4.39
10.1
7
0.0%
0.04 [-1.01, 1.08]
Farnsworth 2003
4.84
1.1
21
5.34
1
21
0.0%
-0.47 [-1.08, 0.15]
Jenkins 2001
5.85
0.7
10
6.06
0.7
10
2.0%
-0.29 [-1.17, 0.59]
Johnston 2004
4.52
0.7
9
4.36
0.4
7
1.7%
0.26 [-0.74, 1.25]
Keogh 2007
4.52
3
13
4.78
4.8
12
0.0%
-0.06 [-0.85, 0.72]
Mamo 2005
5.1
0.2
10
5.7
0.4
10
1.5%
-1.82 [-2.90, -0.74]
Volek 2003
5.34
0.89
5
4.35
0.88
5
1.1%
1.01 [-0.35, 2.37]
Wolfe 1991
5.34
0.85
5
6.5
0.58
5
0.9%
-1.44 [-2.92, 0.04]
Wolfe 1992
7.1
1.4
3
7.8
0.3
2
0.6%
-0.44 [-2.33, 1.44]
Wolfe 1999
3.8
0.6
5
4.1
0.3
5
1.2%
-0.57 [-1.85, 0.71]
Subtotal (95% CI)
54
50 10.4%
-0.42 [-1.03, 0.20]
Heterogeneity: Tau² = 0.40; Chi² = 14.69, df = 7 (P = 0.04); I² = 52%
Test for overall effect: Z = 1.32 (P = 0.19)
7.10.3 at 2 months
Abete 2009
4.31
1.01
9
4.47
0.68
10
Brehm 2005
5.01
0.82
20
4.67
1.01
20
Brinkworth 2009
5.1
1.2
52
4.8
0.7
47
Buscemi 2009
4.71
0.98
10
5.15
1.23
10
de Luis 2009a
4.82
1.02
97
5.11
0.86
96
Farnsworth 2003
4.91
0.9
21
5.26
0.9
21
Farnsworth 2003
4.7
0.6
7
4.59
0.9
7
Hodgson 2006
4.9
0.8
29
4.9
0.8
31
Kleiner 2006
5.36
0.62
9
4.62
0.66
7
Mahon 2007
5.64
1.37
14
6.21
1.09
14
McAuley 2005
5
0.8
30
5.3
0.9
31
Meckling 2004
6
1.1
15
4.29
1.03
16
Noakes 2006
5.68
1.4
24
5.27
1.2
21
Stoernell 2008
4.47
0.45
10
4.73
1.19
13
Te Morenga 2011
4.7
0.9
37
4.7
0.7
37
Subtotal (95% CI)
304
306
Heterogeneity: Tau² = 0.14; Chi² = 28.84, df = 11 (P = 0.002); I² = 62%
Test for overall effect: Z = 0.39 (P = 0.69)
1.9%
2.8%
0.0%
2.0%
4.4%
0.0%
0.0%
3.3%
1.5%
2.4%
3.3%
2.1%
3.0%
2.1%
3.6%
32.3%
-0.18 [-1.08, 0.72]
0.36 [-0.26, 0.99]
0.30 [-0.10, 0.70]
-0.38 [-1.27, 0.51]
-0.31 [-0.59, -0.02]
-0.38 [-0.99, 0.23]
0.13 [-0.91, 1.18]
0.00 [-0.51, 0.51]
1.10 [0.02, 2.18]
-0.45 [-1.20, 0.30]
-0.35 [-0.85, 0.16]
1.56 [0.75, 2.38]
0.31 [-0.28, 0.90]
-0.26 [-1.09, 0.56]
0.00 [-0.46, 0.46]
0.06 [-0.23, 0.34]
2.7%
0.0%
4.0%
1.2%
0.0%
0.0%
2.7%
3.3%
0.0%
2.2%
2.2%
2.9%
3.2%
2.0%
1.7%
2.3%
3.9%
2.8%
37.1%
-0.46 [-1.13, 0.20]
0.35 [-0.26, 0.96]
0.27 [-0.10, 0.63]
0.24 [-1.03, 1.51]
-0.36 [-0.97, 0.25]
0.15 [-0.90, 1.20]
0.29 [-0.37, 0.96]
0.00 [-0.51, 0.51]
-0.06 [-0.85, 0.72]
0.47 [-0.34, 1.28]
0.23 [-0.57, 1.04]
-0.73 [-1.33, -0.12]
0.28 [-0.25, 0.81]
1.06 [0.21, 1.91]
-0.82 [-1.79, 0.16]
-0.88 [-1.66, -0.09]
-0.26 [-0.66, 0.13]
0.06 [-0.56, 0.67]
-0.02 [-0.27, 0.23]
20
43
23
8
27
201
279
2.8%
0.0%
3.0%
1.6%
3.2%
4.7%
15.3%
0.74 [0.11, 1.36]
0.50 [0.07, 0.92]
-0.46 [-1.05, 0.12]
-0.32 [-1.34, 0.71]
0.24 [-0.29, 0.77]
0.31 [0.12, 0.51]
0.17 [-0.19, 0.53]
36
5
41
3.5%
1.4%
4.9%
0.42 [-0.06, 0.90]
-0.34 [-1.47, 0.79]
0.22 [-0.45, 0.88]
Total (95% CI)
985
991 100.0%
Heterogeneity: Tau² = 0.13; Chi² = 96.76, df = 40 (P < 0.00001); I² = 59%
Test for overall effect: Z = 0.00 (P = 1.00)
Test for subgroup differences: Chi² = 3.11, df = 4 (P = 0.54), I² = 0%
0.00 [-0.16, 0.16]
7.10.5 at 3 months
Ballesteros-Pomar 2010
4.45
1.11
18
4.94
0.95
18
Brehm 2003
4.8
0.68
22
4.56
0.68
20
de Luis 2009b
5.04
0.8
52
4.77
1.14
66
Dyson 2007
5.7
1.2
6
5.4
1
4
Farnsworth 2003
4.92
1
21
5.31
1.1
21
Farnsworth 2003
4.69
0.69
7
4.55
1
7
Iglay 2007
4.97
0.88
18
4.71
0.85
17
Josse 2011a
4.39
0.13
30
4.39
0.11
30
Keogh 2007
4.59
3.1
13
4.82
3.8
12
Layman 2005
5.35
1
12
4.91
0.8
12
Layman 2005
4.8
0.8
12
4.63
0.6
12
Leidy 2007
4.09
0.59
21
4.55
0.65
25
Luscombe-Marsh 2005
5.2
1.1
26
4.9
1
30
Meckling 2007
4.5
0.8
14
3.28
1.42
11
Meckling 2007
3.13
1.09
10
6.36
5.56
8
Moran 2003
4.87
0.9
14
5.56
0.6
14
Noakes 2005
5.26
1.1
52
5.54
1
48
Volek 2009
5.08
0.9
20
5.03
0.88
20
Subtotal (95% CI)
305
315
Heterogeneity: Tau² = 0.11; Chi² = 28.29, df = 13 (P = 0.008); I² = 54%
Test for overall effect: Z = 0.18 (P = 0.85)
7.10.7 at 6 months
Brehm 2003
5.31
0.82
22
4.73
0.72
Brinkworth 2009
5.37
1.19
45
4.85
0.84
Due 2004
4.6
0.8
23
5
0.9
Ferrara 2006
3.23
1.1
7
3.57
0.92
Lopez-Jimenez 2010
4.88
0.74
28
4.71
0.65
Sacks 2009
5.15
0.91
201
4.86
0.93
Subtotal (95% CI)
281
Heterogeneity: Tau² = 0.09; Chi² = 9.55, df = 4 (P = 0.05); I² = 58%
Test for overall effect: Z = 0.92 (P = 0.36)
7.10.9 more than 6 months
Brinkworth 2009
6
1.15
33
5.5
1.2
Keogh 2007
4.62
0.7
8
4.94
1.1
Subtotal (95% CI)
41
Heterogeneity: Tau² = 0.10; Chi² = 1.49, df = 1 (P = 0.22); I² = 33%
Test for overall effect: Z = 0.64 (P = 0.52)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
0
1
2
Favours higher protein Favours lower protein
56
57
LDL cholesterol
Higher protein diet lower protein diet
Std. Mean Difference
Study or Subgroup
Mean
SD Total Mean
SD Total Weight
IV, Random, 95% CI
7.14.2 at 1 month
Baba 1999
2.03
0.7
7
1.88
0.7
6
1.2%
0.20 [-0.89, 1.29]
Farnsworth 2003
3.32
1
21
3.59
1
21
0.0%
-0.26 [-0.87, 0.34]
Farnsworth 2003
3.1
0.4
7
2.89
0.7
7
0.0%
0.34 [-0.71, 1.40]
Jenkins 2001
3.86
0.6
10
3.64
0.6
10
1.7%
0.35 [-0.53, 1.24]
Keogh 2007
2.86
2.7
13
3.01
4.6
12
0.0%
-0.04 [-0.82, 0.75]
Mamo 2005
3.1
0.2
10
3.5
0.4
10
1.5%
-1.21 [-2.18, -0.24]
Volek 2003
3.37 0.62
5
2.96
0.67
5
1.0%
0.57 [-0.71, 1.85]
Wolfe 1991
4.22 0.88
5
5.08
0.57
5
0.9%
-1.05 [-2.42, 0.33]
Wolfe 1992
5.5
0.6
3
5.2
0.4
2
0.5%
0.40 [-1.47, 2.27]
Wolfe 1999
2.4
0.3
5
2.6
0.3
5
1.0%
-0.60 [-1.89, 0.68]
Subtotal (95% CI)
45
43
7.8%
-0.22 [-0.79, 0.36]
Heterogeneity: Tau² = 0.23; Chi² = 9.80, df = 6 (P = 0.13); I² = 39%
Test for overall effect: Z = 0.74 (P = 0.46)
7.14.4 at 2 months
Abete 2009
2.98 0.89
9
2.79
0.61
10
Brehm 2005
3.36
0.8
20
2.87
0.9
20
Brinkworth 2009
3.1
1.1
52
2.9
0.6
47
Buscemi 2009
3.03
0.9
10
3.26
1.1
10
de Luis 2009a
2.79
0.9
97
3.06
1.2
96
Farnsworth 2003
3.09
0.4
7
2.93
0.9
7
Farnsworth 2003
3.26
0.8
21
3.47
0.9
21
Hodgson 2006
3
0.7
29
2.7
0.8
31
Kleiner 2006
3.5
0.6
9
2.87
1
7
Mahon 2007
3.62
1
14
3.65
0.85
14
McAuley 2005
3.3
0.7
30
3.6
0.9
31
Meckling 2004
4.4
1
15
2.92
0.9
16
Noakes 2006
3.89
1.4
24
3.54
1.1
21
Stoernell 2008
2.83 0.45
10
2.88
1.1
13
Te Morenga 2011
3
0.8
37
2.9
0.6
37
Subtotal (95% CI)
304
306
Heterogeneity: Tau² = 0.13; Chi² = 26.85, df = 11 (P = 0.005); I² = 59%
Test for overall effect: Z = 1.35 (P = 0.18)
1.6%
2.5%
0.0%
1.7%
4.4%
0.0%
0.0%
3.1%
1.4%
2.1%
3.1%
1.9%
2.7%
1.9%
3.4%
30.0%
0.24 [-0.66, 1.15]
0.56 [-0.07, 1.20]
0.22 [-0.17, 0.62]
-0.22 [-1.10, 0.66]
-0.25 [-0.54, 0.03]
0.22 [-0.84, 1.27]
-0.24 [-0.85, 0.37]
0.39 [-0.12, 0.90]
0.75 [-0.28, 1.78]
-0.03 [-0.77, 0.71]
-0.37 [-0.87, 0.14]
1.52 [0.71, 2.33]
0.27 [-0.32, 0.86]
-0.05 [-0.88, 0.77]
0.14 [-0.32, 0.60]
0.19 [-0.09, 0.47]
2.5%
0.0%
3.9%
1.0%
1.3%
2.7%
2.4%
3.1%
0.0%
1.9%
1.9%
3.2%
2.6%
3.0%
1.8%
1.5%
2.0%
3.8%
2.6%
41.2%
-0.25 [-0.90, 0.41]
0.32 [-0.29, 0.93]
0.19 [-0.18, 0.55]
0.18 [-1.09, 1.45]
0.19 [-0.86, 1.24]
0.24 [-0.36, 0.85]
0.30 [-0.37, 0.97]
-0.19 [-0.69, 0.32]
-0.03 [-0.82, 0.75]
0.68 [-0.15, 1.51]
0.30 [-0.50, 1.11]
0.79 [0.30, 1.28]
-0.94 [-1.56, -0.33]
0.39 [-0.14, 0.93]
0.93 [0.10, 1.77]
-0.73 [-1.70, 0.24]
-0.86 [-1.64, -0.08]
-0.20 [-0.59, 0.19]
0.29 [-0.33, 0.92]
0.08 [-0.16, 0.33]
20
43
23
27
37
201
308
2.6%
0.0%
2.8%
3.0%
3.3%
4.8%
16.6%
0.59 [-0.03, 1.21]
0.46 [0.03, 0.88]
-0.33 [-0.91, 0.25]
0.29 [-0.25, 0.82]
0.01 [-0.46, 0.48]
0.27 [0.07, 0.47]
0.19 [-0.04, 0.42]
36
5
41
3.3%
1.2%
4.5%
0.34 [-0.14, 0.81]
-0.36 [-1.48, 0.77]
0.19 [-0.37, 0.74]
Total (95% CI)
1071
1071 100.0%
Heterogeneity: Tau² = 0.10; Chi² = 88.29, df = 42 (P < 0.0001); I² = 52%
Test for overall effect: Z = 1.48 (P = 0.14)
Test for subgroup differences: Chi² = 2.01, df = 4 (P = 0.73), I² = 0%
0.11 [-0.03, 0.25]
7.14.5 at 3 months
Ballesteros-Pomar 2010
2.64 0.91
18
2.93
1.36
18
Brehm 2003
2.92
0.6
22
2.71
0.7
20
de Luis 2009b
2.97
0.8
52
2.81
0.9
66
Dyson 2007
3.6
1
6
3.4
0.95
4
Farnsworth 2003
3.05
0.5
7
2.9
0.9
7
Farnsworth 2003
3.76
0.7
21
3.53
1.1
21
Iglay 2007
3.1
0.8
18
2.87
0.7
17
Josse 2011a
2.51 0.12
30
2.53
0.09
30
Keogh 2007
2.88
2.9
13
2.98
3.4
12
Layman 2005
3.54
0.8
12
3.07
0.5
12
Layman 2005
3.11
0.7
12
2.93
0.4
12
Layman 2009
3.61 0.58
41
3.08
0.77
30
Leidy 2007
2
0.5
21
2.48
0.5
25
Luscombe-Marsh 2005
3.5
1
26
3.1
1
30
Meckling 2007
3.36
0.8
14
2.4
1.2
11
Meckling 2007
1.97
1
10
4.91
5.7
8
Moran 2003
3.23 0.79
14
3.81
0.49
14
Noakes 2005
3.53
0.9
52
3.71
0.9
48
Volek 2009
3.5
0.8
20
3.26
0.8
20
Subtotal (95% CI)
374
373
Heterogeneity: Tau² = 0.15; Chi² = 40.02, df = 16 (P = 0.0008); I² = 60%
Test for overall effect: Z = 0.65 (P = 0.52)
7.14.7 at 6 months
Brehm 2003
3.21
0.7
22
2.79
0.7
Brinkworth 2009
3.19 0.94
45
2.8
0.74
Due 2004
2.8
0.9
23
3.1
0.9
Lopez-Jimenez 2010
3.21
0.6
28
3.04
0.57
Morgan 2009
3.56 0.76
33
3.55
0.73
Sacks 2009
3.21
0.8
201
3
0.75
Subtotal (95% CI)
307
Heterogeneity: Tau² = 0.02; Chi² = 5.81, df = 4 (P = 0.21); I² = 31%
Test for overall effect: Z = 1.59 (P = 0.11)
7.14.9 more than 6 months
Brinkworth 2009
3.8 1.15
33
3.4
1.2
Keogh 2007
2.69
0.8
8
3.01
0.9
Subtotal (95% CI)
41
Heterogeneity: Tau² = 0.04; Chi² = 1.22, df = 1 (P = 0.27); I² = 18%
Test for overall effect: Z = 0.66 (P = 0.51)
Std. Mean Difference
IV, Random, 95% CI
-2
-1
0
1
2
Favours lower protein
Favours higher protein
57
58
Triglycerides
Higher protein diet lower protein diet
Std. Mean Difference
Study or Subgroup
Mean
SD Total Mean
SD Total Weight
IV, Random, 95% CI
7.16.1 at 1 month
Baba 1999
1.08
0.6
7
1.06
0.4
6
1.6%
0.04 [-1.05, 1.13]
Farnsworth 2003
1.36
0.4
7
1.33
0.4
7
0.0%
0.07 [-0.98, 1.12]
Farnsworth 2003
1.37
0.5
21
1.69
0.5
21
0.0%
-0.63 [-1.25, -0.01]
Jenkins 2001
2.07
0.7
10
2.79
1.1
10
1.9%
-0.75 [-1.66, 0.17]
Keogh 2007
1.2
2.1
13
1.13
1.8
12
0.0%
0.03 [-0.75, 0.82]
Mamo 2005
1.4
0.4
10
2.2
0.3
10
1.5%
-2.17 [-3.32, -1.01]
Volek 2003
0.6 0.14
5
0.82
0.28
5
1.3%
-0.90 [-2.24, 0.44]
Wolfe 1991
1.62 0.23
5
2.44
0.56
5
1.0%
-1.73 [-3.31, -0.15]
Wolfe 1992
1.5
0.6
3
2.65
0.6
2
0.5%
-1.39 [-3.99, 1.20]
Wolfe 1999
0.69
0.1
5
0.95
0.2
5
1.1%
-1.49 [-2.98, 0.01]
Subtotal (95% CI)
45
43
8.9%
-1.10 [-1.71, -0.49]
Heterogeneity: Tau² = 0.22; Chi² = 8.99, df = 6 (P = 0.17); I² = 33%
Test for overall effect: Z = 3.53 (P = 0.0004)
7.16.3 at 2 months
Abete 2009
0.96 0.48
9
1.11
0.56
10
Brehm 2005
0.89
0.2
20
1.46
0.5
20
Brinkworth 2009
1.1
0.4
52
1.5
0.9
47
Buscemi 2009
0.88
0.2
10
1.11
0.4
10
de Luis 2009a
1.19
0.5
97
1.34
0.5
96
Farnsworth 2003
1.43
0.5
21
1.66
0.5
21
Farnsworth 2003
1.56
0.7
7
1.52
0.7
7
Hodgson 2006
1.35 0.76
29
1.31
1.16
31
Kleiner 2006
1.73
1.4
9
1.56
0.9
7
Mahon 2007
1.17
0.5
14
1.95
1
14
McAuley 2005
1.23 0.43
30
1.46
0.51
31
Meckling 2004
1.08
0.7
15
1.13
0.5
16
Noakes 2006
1.16
0.5
24
1.29
0.5
21
Stoernell 2008
1.33 0.61
10
2.08
1.52
13
Te Morenga 2011
1.2
0.5
37
1.2
0.5
37
Subtotal (95% CI)
304
306
Heterogeneity: Tau² = 0.07; Chi² = 19.24, df = 11 (P = 0.06); I² = 43%
Test for overall effect: Z = 3.09 (P = 0.002)
2.0%
2.4%
0.0%
2.0%
3.4%
0.0%
0.0%
2.9%
1.8%
2.2%
2.9%
2.4%
2.7%
2.1%
3.0%
29.6%
7.16.5 at 3 months
Ballesteros-Pomar 2010
1.02 0.42
18
1.37
0.68
18
2.5%
Brehm 2003
1.04
0.5
22
1.15
0.3
20
0.0%
de Luis 2009b
1.42
0.5
52
1.1
0.4
66
3.2%
Dyson 2007
1.5
1.1
6
1.3
0.6
4
1.4%
Farnsworth 2003
1.31
0.5
7
1.62
0.7
7
1.7%
Farnsworth 2003
1.34
0.5
21
1.67
0.6
21
2.6%
Iglay 2007
1.08
0.3
18
1.2
0.5
17
2.5%
Josse 2011a
0.81 0.06
30
1.09
0.11
30
2.3%
Keogh 2007
1.06
1.8
13
1.11
2.1
12
0.0%
Layman 2005
1.12
0.4
12
1.38
0.6
12
2.2%
Layman 2005
0.98
0.6
12
0.91
0.5
12
2.2%
Layman 2009
1.37 0.58
41
1.09
0.38
30
2.9%
Leidy 2007
0.96
0.6
21
1.24
0.5
25
2.7%
Luscombe-Marsh 2005
1.4
0.7
26
1.7
1
30
2.8%
Meckling 2007
1.22
0.3
14
0.98
0.3
11
2.1%
Meckling 2007
1.59
0.6
10
2.05
1.2
8
1.9%
Moran 2003
1.33 0.64
14
1.42
0.52
14
2.3%
Noakes 2005
1.07
0.4
52
1.35
0.7
48
3.1%
Volek 2009
1.17
0.5
20
1.71
0.4
20
2.5%
Subtotal (95% CI)
374
373 40.7%
Heterogeneity: Tau² = 0.60; Chi² = 109.07, df = 16 (P < 0.00001); I² = 85%
Test for overall effect: Z = 1.77 (P = 0.08)
7.16.7 at 6 months
Brehm 2003
1.29
0.8
22
1.25
0.6
20
Brinkworth 2009
0.96 0.35
45
1.43
0.96
43
Due 2004
1.2
0.5
23
1.5
0.6
23
Ferrara 2006
0.57
0.4
7
0.49
0.3
8
Lopez-Jimenez 2010
1.45
0.5
28
1.5
0.67
27
Morgan 2009
1.01 0.33
33
1.38
0.65
37
Sacks 2009
1.29
0.8
201
1.31
0.82
201
Subtotal (95% CI)
314
316
Heterogeneity: Tau² = 0.05; Chi² = 9.03, df = 5 (P = 0.11); I² = 45%
Test for overall effect: Z = 1.44 (P = 0.15)
-0.27 [-1.18, 0.63]
-1.47 [-2.17, -0.76]
-0.58 [-0.98, -0.18]
-0.70 [-1.61, 0.21]
-0.30 [-0.58, -0.02]
-0.45 [-1.06, 0.16]
0.05 [-0.99, 1.10]
0.04 [-0.47, 0.55]
0.13 [-0.86, 1.12]
-0.96 [-1.75, -0.17]
-0.48 [-0.99, 0.03]
-0.08 [-0.79, 0.62]
-0.26 [-0.84, 0.33]
-0.59 [-1.44, 0.25]
0.00 [-0.46, 0.46]
-0.37 [-0.60, -0.13]
-0.61 [-1.28, 0.06]
-0.26 [-0.87, 0.35]
0.71 [0.34, 1.09]
0.19 [-1.08, 1.46]
-0.48 [-1.55, 0.59]
-0.59 [-1.21, 0.03]
-0.29 [-0.95, 0.38]
-3.12 [-3.89, -2.35]
-0.02 [-0.81, 0.76]
-0.49 [-1.31, 0.32]
0.12 [-0.68, 0.92]
0.55 [0.07, 1.03]
-0.50 [-1.09, 0.09]
-0.34 [-0.87, 0.19]
0.77 [-0.05, 1.60]
-0.48 [-1.43, 0.47]
-0.15 [-0.89, 0.59]
-0.49 [-0.89, -0.09]
-1.17 [-1.84, -0.49]
-0.37 [-0.78, 0.04]
2.6%
0.0%
2.7%
1.8%
2.8%
2.9%
3.5%
16.3%
0.06 [-0.55, 0.66]
-0.65 [-1.08, -0.22]
-0.53 [-1.12, 0.06]
0.22 [-0.80, 1.23]
-0.08 [-0.61, 0.45]
-0.70 [-1.18, -0.21]
-0.02 [-0.22, 0.17]
-0.20 [-0.47, 0.07]
2.9%
1.5%
4.5%
-0.52 [-1.00, -0.04]
-0.64 [-1.79, 0.52]
-0.54 [-0.98, -0.09]
Total (95% CI)
1078
1079 100.0%
Heterogeneity: Tau² = 0.25; Chi² = 161.94, df = 43 (P < 0.00001); I² = 73%
Test for overall effect: Z = 4.39 (P < 0.0001)
Test for subgroup differences: Chi² = 7.59, df = 4 (P = 0.11), I² = 47.3%
-0.42 [-0.61, -0.23]
7.16.9 more than 6 months
Brinkworth 2009
1.09 0.63
33
1.58
1.14
Keogh 2007
1.07
0.2
8
1.34
0.6
Subtotal (95% CI)
41
Heterogeneity: Tau² = 0.00; Chi² = 0.03, df = 1 (P = 0.86); I² = 0%
Test for overall effect: Z = 2.37 (P = 0.02)
36
5
41
Std. Mean Difference
IV, Random, 95% CI
-4
-2
0
2
4
Favours higher protein Favours lower protein
58
59
Fasting blood glucose
Higher protein
lower protein diet
Std. Mean Difference
Study or Subgroup
Mean
SD Total Mean
SD Total Weight IV, Random, 95% CI
7.18.1 at 1 month
Baba 1999
5
0.2
7
5.1
0.4
6
1.0%
-0.30 [-1.40, 0.80]
Farnsworth 2003
5.3
0.5
28
5.3
0.5
29
0.0%
0.00 [-0.52, 0.52]
Keogh 2007
5.44
1.6
13
5.5
1.8
12
0.0%
-0.03 [-0.82, 0.75]
Phillips 2008
5
0.4
10
5
0.3
10
1.5%
0.00 [-0.88, 0.88]
Subtotal (95% CI)
17
16
2.4%
-0.12 [-0.80, 0.57]
Heterogeneity: Tau² = 0.00; Chi² = 0.18, df = 1 (P = 0.67); I² = 0%
Test for overall effect: Z = 0.34 (P = 0.74)
7.18.3 at 2 months
Abete 2009
4.79 0.26
9 4.99 0.32
10
Brinkworth 2009
5.5
0.5
52
5.4
0.5
47
Buscemi 2009
5.1
0.7
10
5.2
0.7
10
de Luis 2009a
5.3
0.8
97
5.1
0.7
96
Farnsworth 2003
5.6
0.5
28
5.2
5
29
Hodgson 2006
5.1
0.8
29
4.7
0.6
31
Kleiner 2006
6.1
2
9
5.9
0.9
7
Luscombe-Marsh 2005
5.4
0.5
27
5.5
0.7
30
McAuley 2005
5
0.6
30
4.8
0.4
31
Meckling 2004
5.8
2.1
15
4.9
0.7
16
Noakes 2006
5.3
0.5
24
5.2
0.5
21
Subtotal (95% CI)
223
222
Heterogeneity: Tau² = 0.00; Chi² = 6.83, df = 7 (P = 0.45); I² = 0%
Test for overall effect: Z = 2.86 (P = 0.004)
1.3%
0.0%
1.5%
7.9%
0.0%
3.6%
1.2%
0.0%
3.7%
2.1%
2.9%
24.1%
7.18.5 at 3 months
Ballesteros-Pomar 2010 4.46 0.44
18 4.47 0.53
18
2.4%
Belobrajdic 2010
5.6 0.5831
34
5.6 0.6481
42
4.4%
Bowden 2007
4.9
0.4
7
4.8
0.5
38
1.7%
Bowden 2007
4.8
0.3
15
5
0.4
34
2.7%
Brehm 2003
5.2
0.7
22
5
0.6
20
0.0%
de Luis 2009b
5.1
0.67
52
5.2
0.8
66
5.9%
Farnsworth 2003
5.4
0.3
28
5.2
0.5
29
3.5%
Josse 2011a
4.9
0.1
30
4.9
0.1
30
3.7%
Keogh 2007
5.52
1.5
13 5.48
1.7
12
0.0%
Leidy 2007
4.8
0.3
21
4.9
0.6
25
3.0%
Luscombe-Marsh 2005
5.4
0.5
27
5.5
0.6
30
3.5%
Meckling 2007
5.7
0.6
14
5.1
0.5
11
1.5%
Meckling 2007
5
0.9
10
4.8
0.3
8
1.3%
Moran 2003
5.42
0.5
14 5.31 0.64
14
2.0%
Noakes 2005
5.93
4.4
52 5.83
4.3
48
5.4%
Volek 2009
4.9
0.4
20
5.2
0.5
20
2.5%
Subtotal (95% CI)
342
413 43.5%
Heterogeneity: Tau² = 0.03; Chi² = 17.82, df = 13 (P = 0.16); I² = 27%
Test for overall effect: Z = 0.15 (P = 0.88)
7.18.7 at 6 months
Brehm 2003
5
0.54
22
4.9
0.5
20
Brinkworth 2009
5.49 0.48
45 5.38 0.49
43
Due 2004
4.9
0.5
23
5.1
0.8
23
Ferrara 2006
4.4
0.4
7
4.9
0.5
8
Lopez-Jimenez 2010
5.56 0.77
28 5.47 0.61
27
Morgan 2009
5.3
0.61
33 5.18 0.51
37
Sacks 2009
5.01 0.66 201 4.95 0.61 201
Subtotal (95% CI)
314
316
Heterogeneity: Tau² = 0.01; Chi² = 5.94, df = 5 (P = 0.31); I² = 16%
Test for overall effect: Z = 0.48 (P = 0.63)
-0.65 [-1.58, 0.28]
0.20 [-0.20, 0.59]
-0.14 [-1.01, 0.74]
0.26 [-0.02, 0.55]
0.11 [-0.41, 0.63]
0.56 [0.04, 1.08]
0.12 [-0.87, 1.11]
-0.16 [-0.68, 0.36]
0.39 [-0.12, 0.90]
0.57 [-0.15, 1.29]
0.20 [-0.39, 0.78]
0.27 [0.09, 0.46]
-0.02 [-0.67, 0.63]
0.00 [-0.45, 0.45]
0.20 [-0.61, 1.01]
-0.53 [-1.14, 0.09]
0.30 [-0.31, 0.91]
-0.13 [-0.50, 0.23]
0.48 [-0.05, 1.00]
0.00 [-0.51, 0.51]
0.02 [-0.76, 0.81]
-0.20 [-0.78, 0.38]
-0.18 [-0.70, 0.34]
1.04 [0.19, 1.89]
0.27 [-0.66, 1.21]
0.19 [-0.56, 0.93]
0.02 [-0.37, 0.42]
-0.65 [-1.29, -0.01]
-0.01 [-0.19, 0.16]
2.8%
0.0%
3.0%
1.0%
3.5%
4.1%
10.8%
25.1%
0.19 [-0.42, 0.80]
0.22 [-0.19, 0.64]
-0.29 [-0.88, 0.29]
-1.03 [-2.13, 0.07]
0.13 [-0.40, 0.66]
0.21 [-0.26, 0.68]
0.09 [-0.10, 0.29]
0.05 [-0.15, 0.25]
4.1%
0.8%
4.9%
0.17 [-0.30, 0.64]
-0.85 [-2.03, 0.34]
-0.19 [-1.14, 0.76]
Total (95% CI)
937
1008 100.0%
Heterogeneity: Tau² = 0.02; Chi² = 39.55, df = 31 (P = 0.14); I² = 22%
Test for overall effect: Z = 1.13 (P = 0.26)
Test for subgroup differences: Chi² = 5.82, df = 4 (P = 0.21), I² = 31.3%
0.06 [-0.05, 0.17]
7.18.9 more than 6 months
Brinkworth 2009
5.4
0.57
33
5.3
0.6
36
Keogh 2007
5.19
0.4
8
5.5
0.2
5
Subtotal (95% CI)
41
41
Heterogeneity: Tau² = 0.30; Chi² = 2.43, df = 1 (P = 0.12); I² = 59%
Test for overall effect: Z = 0.39 (P = 0.70)
Std. Mean Difference
IV, Random, 95% CI
-1 -0.5 0
0.5 1
Favours higher protein Favours lower protein
59
60
Fasting blood insulin
Higher protein
lower protein diet
Std. Mean Difference
Study or Subgroup
Mean
SD Total Mean
SD Total Weight IV, Random, 95% CI
7.18.1 at 1 month
Baba 1999
5
0.2
7
5.1
0.4
6
1.0%
-0.30 [-1.40, 0.80]
Farnsworth 2003
5.3
0.5
28
5.3
0.5
29
0.0%
0.00 [-0.52, 0.52]
Keogh 2007
5.44
1.6
13
5.5
1.8
12
0.0%
-0.03 [-0.82, 0.75]
Phillips 2008
5
0.4
10
5
0.3
10
1.5%
0.00 [-0.88, 0.88]
Subtotal (95% CI)
17
16
2.4%
-0.12 [-0.80, 0.57]
Heterogeneity: Tau² = 0.00; Chi² = 0.18, df = 1 (P = 0.67); I² = 0%
Test for overall effect: Z = 0.34 (P = 0.74)
7.18.3 at 2 months
Abete 2009
4.79 0.26
9 4.99 0.32
10
Brinkworth 2009
5.5
0.5
52
5.4
0.5
47
Buscemi 2009
5.1
0.7
10
5.2
0.7
10
de Luis 2009a
5.3
0.8
97
5.1
0.7
96
Farnsworth 2003
5.6
0.5
28
5.2
5
29
Hodgson 2006
5.1
0.8
29
4.7
0.6
31
Kleiner 2006
6.1
2
9
5.9
0.9
7
Luscombe-Marsh 2005
5.4
0.5
27
5.5
0.7
30
McAuley 2005
5
0.6
30
4.8
0.4
31
Meckling 2004
5.8
2.1
15
4.9
0.7
16
Noakes 2006
5.3
0.5
24
5.2
0.5
21
Subtotal (95% CI)
223
222
Heterogeneity: Tau² = 0.00; Chi² = 6.83, df = 7 (P = 0.45); I² = 0%
Test for overall effect: Z = 2.86 (P = 0.004)
1.3%
0.0%
1.5%
7.9%
0.0%
3.6%
1.2%
0.0%
3.7%
2.1%
2.9%
24.1%
7.18.5 at 3 months
Ballesteros-Pomar 2010 4.46 0.44
18 4.47 0.53
18
2.4%
Belobrajdic 2010
5.6 0.5831
34
5.6 0.6481
42
4.4%
Bowden 2007
4.9
0.4
7
4.8
0.5
38
1.7%
Bowden 2007
4.8
0.3
15
5
0.4
34
2.7%
Brehm 2003
5.2
0.7
22
5
0.6
20
0.0%
de Luis 2009b
5.1
0.67
52
5.2
0.8
66
5.9%
Farnsworth 2003
5.4
0.3
28
5.2
0.5
29
3.5%
Josse 2011a
4.9
0.1
30
4.9
0.1
30
3.7%
Keogh 2007
5.52
1.5
13 5.48
1.7
12
0.0%
Leidy 2007
4.8
0.3
21
4.9
0.6
25
3.0%
Luscombe-Marsh 2005
5.4
0.5
27
5.5
0.6
30
3.5%
Meckling 2007
5.7
0.6
14
5.1
0.5
11
1.5%
Meckling 2007
5
0.9
10
4.8
0.3
8
1.3%
Moran 2003
5.42
0.5
14 5.31 0.64
14
2.0%
Noakes 2005
5.93
4.4
52 5.83
4.3
48
5.4%
Volek 2009
4.9
0.4
20
5.2
0.5
20
2.5%
Subtotal (95% CI)
342
413 43.5%
Heterogeneity: Tau² = 0.03; Chi² = 17.82, df = 13 (P = 0.16); I² = 27%
Test for overall effect: Z = 0.15 (P = 0.88)
7.18.7 at 6 months
Brehm 2003
5
0.54
22
4.9
0.5
20
Brinkworth 2009
5.49 0.48
45 5.38 0.49
43
Due 2004
4.9
0.5
23
5.1
0.8
23
Ferrara 2006
4.4
0.4
7
4.9
0.5
8
Lopez-Jimenez 2010
5.56 0.77
28 5.47 0.61
27
Morgan 2009
5.3
0.61
33 5.18 0.51
37
Sacks 2009
5.01 0.66 201 4.95 0.61 201
Subtotal (95% CI)
314
316
Heterogeneity: Tau² = 0.01; Chi² = 5.94, df = 5 (P = 0.31); I² = 16%
Test for overall effect: Z = 0.48 (P = 0.63)
-0.65 [-1.58, 0.28]
0.20 [-0.20, 0.59]
-0.14 [-1.01, 0.74]
0.26 [-0.02, 0.55]
0.11 [-0.41, 0.63]
0.56 [0.04, 1.08]
0.12 [-0.87, 1.11]
-0.16 [-0.68, 0.36]
0.39 [-0.12, 0.90]
0.57 [-0.15, 1.29]
0.20 [-0.39, 0.78]
0.27 [0.09, 0.46]
-0.02 [-0.67, 0.63]
0.00 [-0.45, 0.45]
0.20 [-0.61, 1.01]
-0.53 [-1.14, 0.09]
0.30 [-0.31, 0.91]
-0.13 [-0.50, 0.23]
0.48 [-0.05, 1.00]
0.00 [-0.51, 0.51]
0.02 [-0.76, 0.81]
-0.20 [-0.78, 0.38]
-0.18 [-0.70, 0.34]
1.04 [0.19, 1.89]
0.27 [-0.66, 1.21]
0.19 [-0.56, 0.93]
0.02 [-0.37, 0.42]
-0.65 [-1.29, -0.01]
-0.01 [-0.19, 0.16]
2.8%
0.0%
3.0%
1.0%
3.5%
4.1%
10.8%
25.1%
0.19 [-0.42, 0.80]
0.22 [-0.19, 0.64]
-0.29 [-0.88, 0.29]
-1.03 [-2.13, 0.07]
0.13 [-0.40, 0.66]
0.21 [-0.26, 0.68]
0.09 [-0.10, 0.29]
0.05 [-0.15, 0.25]
4.1%
0.8%
4.9%
0.17 [-0.30, 0.64]
-0.85 [-2.03, 0.34]
-0.19 [-1.14, 0.76]
Total (95% CI)
937
1008 100.0%
Heterogeneity: Tau² = 0.02; Chi² = 39.55, df = 31 (P = 0.14); I² = 22%
Test for overall effect: Z = 1.13 (P = 0.26)
Test for subgroup differences: Chi² = 5.82, df = 4 (P = 0.21), I² = 31.3%
0.06 [-0.05, 0.17]
7.18.9 more than 6 months
Brinkworth 2009
5.4
0.57
33
5.3
0.6
36
Keogh 2007
5.19
0.4
8
5.5
0.2
5
Subtotal (95% CI)
41
41
Heterogeneity: Tau² = 0.30; Chi² = 2.43, df = 1 (P = 0.12); I² = 59%
Test for overall effect: Z = 0.39 (P = 0.70)
Std. Mean Difference
IV, Random, 95% CI
-1 -0.5
Favours higher
0
0.5 1
Favours lower
60
61
C-reactive protein
Higher protein diets
Study or Subgroup
Mean
SD
Lower protein diets
Total
Mean
SD
Std. Mean Difference
Total Weight
IV, Random, 95% CI
Std. Mean Difference
IV, Random, 95% CI
7.21.1 at 1 month
Baba 1999
142.4
38.9
7
190.3
50.7
6
2.6%
Farnsworth 2003
87.5
40.3
28
86.8
48.6
29
0.0%
0.02 [-0.50, 0.53]
Mamo 2005
57.6
6.9
10
75.7
21.5
10
2.9%
-1.09 [-2.04, -0.13]
10 33.66906 15.10791
27
10
26
3.0%
8.4%
0.00 [-0.88, 0.88]
-0.64 [-1.37, 0.09]
Phillips 2008
Subtotal (95% CI)
33.66906475 14.86811
-1.00 [-2.18, 0.19]
Heterogeneity: Tau² = 0.16; Chi² = 3.23, df = 2 (P = 0.20); I² = 38%
Test for overall effect: Z = 1.73 (P = 0.08)
7.21.3 at 2 months
Abete 2009
53.5
28.5
9
60.4
34
10
3.0%
-0.21 [-1.11, 0.69]
97
8
20
131
12
20
2.9%
-3.27 [-4.24, -2.29]
47.9
34.7
52
54.2
21.5
47
0.0%
-0.21 [-0.61, 0.18]
84
37.5
97
103.5
50.7
96
3.7%
-0.44 [-0.72, -0.15]
Farnsworth 2003
93.8
51.4
28
74.3
33.3
29
0.0%
0.45 [-0.08, 0.97]
Hodgson 2006
82.6
86.8
29
51.4
31.3
31
3.5%
0.48 [-0.04, 0.99]
Keogh 2007
66.2
152.1
13
46.7
74.3
12
0.0%
0.16 [-0.63, 0.94]
Kleiner 2006
208.4
243.8
9
136.1
113.9
7
2.8%
0.34 [-0.65, 1.34]
63.2
25.7
27
69.5
36.1
30
0.0%
-0.20 [-0.72, 0.32]
McAuley 2005
46.5
10.6
30
63.9
10.6
31
3.4%
-1.62 [-2.20, -1.04]
Meckling 2004
117.4
51.4
15
140.3
41.7
16
3.2%
-0.48 [-1.19, 0.24]
56.3
34
24
233
54.9
18.8
21
232
3.4%
25.8%
0.05 [-0.54, 0.63]
-0.61 [-1.27, 0.04]
Brehm 2005
Brinkworth 2009
de Luis 2009a
Luscombe-Marsh 2005
Noakes 2006
Subtotal (95% CI)
Heterogeneity: Tau² = 0.76; Chi² = 65.51, df = 7 (P < 0.00001); I² = 89%
Test for overall effect: Z = 1.84 (P = 0.07)
7.21.5 at 3 months
Ballesteros-Pomar 2010
76.4
58.9
18
71.1
47
18
3.3%
0.10 [-0.56, 0.75]
Brehm 2003
80.6
38.9
22
125.7
77.8
20
0.0%
-0.73 [-1.36, -0.10]
Buscemi 2009
125
13.9
10
104.2
13.9
10
2.8%
1.43 [0.43, 2.44]
de Luis 2009b
106.3
41.7
52
79.9
34
66
3.6%
0.70 [0.32, 1.07]
72.9
25.7
28
72.2
22.2
29
3.5%
0.03 [-0.49, 0.55]
Farnsworth 2003
Josse 2011a
44
6
30
59
7
30
3.3%
-2.27 [-2.93, -1.61]
Keogh 2007
55.4
128.5
13
62.2
130.6
12
0.0%
-0.05 [-0.84, 0.73]
Layman 2005
138.5
27.4
12
133.4
29.8
12
3.1%
0.17 [-0.63, 0.97]
Layman 2005
125.5
37.4
12
141.3
32.2
12
3.1%
-0.44 [-1.25, 0.37]
Luscombe-Marsh 2005
63.9
29.2
27
77.1
81.3
30
3.5%
-0.21 [-0.73, 0.31]
Meckling 2007
102.1
34.7
14
116
46.5
11
3.1%
-0.33 [-1.13, 0.46]
Meckling 2007
110.4
31.9
10
130.6
49.3
8
2.9%
-0.48 [-1.42, 0.47]
Moran 2003
115.3
62.5
14
88.9
52.1
14
3.2%
0.45 [-0.31, 1.20]
Noakes 2005
50.7
25
52
58.3
57.6
48
3.6%
-0.17 [-0.57, 0.22]
54
57
20
299
57
9
20
308
3.3%
42.2%
-0.07 [-0.69, 0.55]
-0.10 [-0.52, 0.33]
Volek 2009
Subtotal (95% CI)
Heterogeneity: Tau² = 0.48; Chi² = 72.52, df = 12 (P < 0.00001); I² = 83%
Test for overall effect: Z = 0.44 (P = 0.66)
7.21.7 at 6 months
Brehm 2003
100
45.8
22
127.8
65.3
20
3.4%
-0.49 [-1.10, 0.13]
Brinkworth 2009
42.9
24.2
45
51.7
23.9
43
0.0%
-0.36 [-0.78, 0.06]
Due 2004
47.4
22.5
23
47.4
33.2
23
3.4%
0.00 [-0.58, 0.58]
Lopez-Jimenez 2010
48.3
30.8
28
61.3
32.8
27
3.4%
-0.40 [-0.94, 0.13]
Morgan 2009
54.8
32.4
33
75.9
45
37
3.5%
-0.53 [-1.01, -0.05]
Sacks 2009
Subtotal (95% CI)
22.6
4.4
201
307
17.6
3.4
201
308
3.7%
17.4%
1.27 [1.05, 1.48]
-0.01 [-0.95, 0.92]
Heterogeneity: Tau² = 1.07; Chi² = 88.24, df = 4 (P < 0.00001); I² = 95%
Test for overall effect: Z = 0.03 (P = 0.98)
7.21.9 more than 6 months
Brinkworth 2009
33.3
19.9
33
45.1
20.8
36
3.5%
-0.57 [-1.06, -0.09]
Keogh 2007
Subtotal (95% CI)
50.6
29.2
8
41
36.3
7.6
5
41
2.6%
6.1%
0.56 [-0.59, 1.71]
-0.13 [-1.21, 0.95]
915 100.0%
-0.26 [-0.59, 0.07]
Heterogeneity: Tau² = 0.44; Chi² = 3.19, df = 1 (P = 0.07); I² = 69%
Test for overall effect: Z = 0.24 (P = 0.81)
Total (95% CI)
907
Heterogeneity: Tau² = 0.75; Chi² = 317.04, df = 30 (P < 0.00001); I² = 91%
Test for overall effect: Z = 1.54 (P = 0.12)
-4
-2
0
2
4
Favours higher protein Favours lower protein
Test for subgroup differences: Chi² = 3.07, df = 4 (P = 0.55), I² = 0%
61