Effects of weight loss during a very low carbohydrate diet on specific adipose tissue depots and insulin sensitivity in older adults with obesity: a randomized clinical trial

Abstract

Background Insulin resistance and accumulation of visceral adipose tissue (VAT) and intermuscular adipose tissue (IMAT) place aging adults with obesity at high risk of cardio-metabolic disease. A very low carbohydrate diet (VLCD) may be a means of promoting fat loss from the visceral cavity and skeletal muscle, without compromising lean mass, and improve insulin sensitivity in aging adults with obesity. Objective To determine if a VLCD promotes a greater loss of fat (total, visceral and intermuscular), preserves lean mass, and improves insulin sensitivity compared to a standard CHO-based/low-fat diet (LFD) in older adults with obesity. Design Thirty-four men and women aged 60–75 years with obesity (body mass index [BMI] 30-40 kg/m 2 ) were randomized to a diet prescription of either a VLCD (< 10:25:> 65% energy from CHO:protein:fat) or LFD diet (55:25:20) for 8 weeks. Body composition by dual-energy X-ray absorptiometry (DXA), fat distribution by magnetic resonance imaging (MRI), insulin sensitivity by euglycemic hyperinsulinemic clamp, and lipids by a fasting blood draw were assessed at baseline and after the intervention. Results Participants lost an average of 9.7 and 2.0% in total fat following the VLCD and LFD, respectively ( p < 0.01). The VLCD group experienced ~ 3-fold greater loss in VAT compared to the LFD group (− 22.8% vs − 1.0%, p < 0.001) and a greater decrease in thigh-IMAT (− 24.4% vs − 1.0%, p < 0.01). The VLCD group also had significantly greater thigh skeletal muscle (SM) at 8 weeks following adjustment for change in total fat mass. Finally, the VLCD had greater increases in insulin sensitivity and HDL-C and decreases in fasting insulin and triglycerides compared to the LFD group. Conclusions Weight loss resulting from consumption of a diet lower in CHO and higher in fat may be beneficial for older adults with obesity by depleting adipose tissue depots most strongly implicated in poor metabolic and functional outcomes and by improving insulin sensitivity and the lipid profile. Trial registration NCT02760641 . Registered 03 May 2016 - Retrospectively registered.

Ketogenic Diet Is Good for Aging-Related Sarcopenic Obesity

“…Therefore, sarcopenic obesity has been defined as the loss of skeletal muscle mass and overweight in the older age. As sarcopenic obesity grow older, up to half of the muscle is lost and skeletal muscle is often replaced with fat tissue, particularly in sarcopenic obesity [15]. This is an importance of sarcopenic obesity in the health care for older people.…”

“…We hoped to obtain the benefits of ketone dietary therapy that could be maintained indefinitely. Ketone bodies were produced β-hydroxybutyrate, acetoacetate, and acetone by the liver in they consumed a very low-carbohydrate, and excess high-fat diet (Figure 1) [11,12].…”

Islet Health, Hormone Secretion, and Insulin Responsivity with Low-Carbohydrate Feeding in Diabetes

“…In most cases, human studies on LCD and KD feeding report significantly reduced fasted and 24 h insulin and increased fasted, non-fasted, and 24 h glucagon compared to control groups or baseline measurement [ 69 , 70 , 71 , 72 , 73 , 74 ]. Interestingly, Samaha and colleagues found decreased insulin levels in severely obese participants currently without DM medications, but not with those using DM medications [ 75 ].…”

Greater Loss of Central Adiposity from Low-Carbohydrate versus Low-Fat Diet in Middle-Aged Adults with Overweight and Obesity

“…LCHF diets are known for rapid weight loss with a greater reduction in body fat and preservation of lean mass, compared to diets that are lower in fat [ 7 , 8 , 9 ]. Further, LCHF diets have been associated with a preferential loss of visceral and ectopic fat among younger adults and limited evidence supports similar benefits in older adults [ 10 ]. Such results would be ideal for older adults and would mitigate concerns about sarcopenia while targeting the most metabolically harmful fat depots.…”

“…Such results would be ideal for older adults and would mitigate concerns about sarcopenia while targeting the most metabolically harmful fat depots. However, the existing evidence is insufficient to determine whether this diet response is consistent across age groups [ 2 , 10 ].…”