Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men

Hall, Kevin D.; Chen, Kong Y.; Guo, Juen; Lam, Yan Y.; Leibel, Rudolph L.; Mayer, Laurel; Reitman, Marc L.; Rosenbaum, Michael; Smith, Steven R.; Walsh, B. Timothy; Ravussin, Éric

doi:10.3945/ajcn.116.133561

Cited by 265 publications

(300 citation statements)

References 47 publications

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“…This is consistent with recent studies showing that LCD does not increase energy expenditure to a relevant extent 30. Waist circumference was not included in the present analysis, but did not differ between groups in the individual studies where it was measured.…”

Section: Discussionsupporting

confidence: 91%

Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes

Snorgaard

Poulsen

Andersen

et al. 2017

BMJ Open Diab Res Care

274

223

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ObjectiveNutrition therapy is an integral part of self-management education in patients with type 2 diabetes. Carbohydrates with a low glycemic index are recommended, but the ideal amount of carbohydrate in the diet is unclear. We performed a meta-analysis comparing diets containing low to moderate amounts of carbohydrate (LCD) (energy percentage below 45%) to diets containing high amounts of carbohydrate (HCD) in subjects with type 2 diabetes.Research design and methodsWe systematically reviewed Cochrane library databases, EMBASE, and MEDLINE in the period 2004–2014 for guidelines, meta-analyses, and randomized trials assessing the outcomes HbA1c, BMI, weight, LDL cholesterol, quality of life (QoL), and attrition.ResultsWe identified 10 randomized trials comprising 1376 participants in total. In the first year of intervention, LCD was followed by a 0.34% lower HbA1c (3.7 mmol/mol) compared with HCD (95% CI 0.06 (0.7 mmol/mol), 0.63 (6.9 mmol/mol)). The greater the carbohydrate restriction, the greater the glucose-lowering effect (R=−0.85, p<0.01). At 1 year or later, however, HbA1c was similar in the 2 diet groups. The effect of the 2 types of diet on BMI/body weight, LDL cholesterol, QoL, and attrition rate was similar throughout interventions.LimitationsGlucose-lowering medication, the nutrition therapy, the amount of carbohydrate in the diet, glycemic index, fat and protein intake, baseline HbA1c, and adherence to the prescribed diets could all have affected the outcomes.ConclusionsLow to moderate carbohydrate diets have greater effect on glycemic control in type 2 diabetes compared with high-carbohydrate diets in the first year of intervention. The greater the carbohydrate restriction, the greater glucose lowering, a relationship that has not been demonstrated earlier. Apart from this lowering of HbA1c over the short term, there is no superiority of low-carbohydrate diets in terms of glycemic control, weight, or LDL cholesterol.

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Section: Discussionsupporting

confidence: 91%

Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes

Snorgaard

Poulsen

Andersen

et al. 2017

BMJ Open Diab Res Care

274

223

View full text Add to dashboard Cite

show abstract

“…Atkins diet) a subsequent study by the same research group (22) reported similar results using a 4-week ketogenic diet (15% protein, 80% fat, 5% carbohydrate), with insulin secretion again significantly reduced (by 47%) but not associated with greater fat loss. The low-carbohydrate, high protein, Atkins' Diet was once marketed as magic: "the high calorie way to stay thin forever" (23), but these findings demonstrate that when calories are held constant no 'metabolic advantage' for LCD's exists.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 66%

Is There an Optimal Diet for Weight Management and Metabolic Health?

Thom

Lean

2017

Gastroenterology

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Individuals can lose body weight and improve health status on a wide range of energy (calorie) restricted dietary interventions. In this paper, we have reviewed the effectiveness of the most commonly utilized diets, including low-fat, low-carbohydrate and Mediterranean approaches in addition to commercial slimming programmes, meal replacements and newly-popularized intermittent fasting diets. We also consider the role of artificial sweeteners in weight management. Low-fat diets tend to improve LDL-cholesterol most, whilst lower-carbohydrate diets may preferentially improve triglycerides and HDLcholesterol, however differences between diets are marginal. Weight loss improves almost all obesity related co-morbidities and metabolic markers, regardless of the macronutrient composition of the diet, but individuals do vary in preferences and ability to adhere to different diets. Optimizing adherence is the most important factor for weight loss success, and this is enhanced by regular professional contact and supportive behavioral change programs. Maintaining weight losses in the long-term remains the biggest challenge, and is undermined by an 'obesogenic' environment and biological adaptations that accompany weight loss.

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“…Daily self-testing of urinary ketones is the norm in the literature [7, 9–11, 15–17], except for one study investigating the capacity for moderate endurance exercise after a KD, where urine ketones were measured twice daily [18]. A few others did collect 24-h urine [19, 20], while others only measured blood ketones [21, 22] or did not even test for ketosis [6]. The International KD Study Group on the optimal clinical management of children following a KD recommends urine ketosis evaluation routinely, several times per week, but they give no advice on when to measure [5].…”

Section: Discussionmentioning

confidence: 99%

Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?

Urbain

Bertz

2016

Nutr Metab (Lond)

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BackgroundThe ketogenic diet (KD) is a very low-carbohydrate, high-fat and adequate-protein diet with no calorie limit that induces a metabolic condition called “physiological ketosis”. It was first introduced to treat epilepsy in the 1920s and has become quite popular recently as weight-loss and performance-enhancing diet. Its therapeutic use in a range of diseases is under investigation. During KD interventions people are supposed to monitor compliance with the dietary regimen by daily urine testing for ketosis. However, there are no studies investigating the best time for testing.FindingsTwelve healthy subjects (37 ± 11 years; BMI = 23.0 ± 2.5 kg/m2) were instructed to, during the sixth week of a KD and with stable ketosis, measure their urine (8×) and blood (18×) ketone concentration at regular intervals during a 24-h period. According to their 1-day food record, the subjects consumed on average a diet with 74.3 ± 4.0 %, 19.5 ± 3.5 %, and 6.2 ± 2.0 % of total energy intake from fat, protein and carbohydrate, respectively. The lowest blood ß-hydroxybutyrate (BHB) (0.33 ± 0.17 mmol/l) and urine acetoacetate (AA) (0.46 ± 0.54 mmol/l) concentrations were measured at 10:00, respectively. The highest BHB (0.70 ± 0.62 mmol/l) and AA concentrations were noted at 03:00, respectively. Via urine testing the highest levels of ketosis were found at 22:00 and 03:00 and the highest detection rates (>90 %) for ketosis were at 07:00, 22:00 and 03:00, respectively.ConclusionsThese results indicate that ketonuria in subjects with stable ketosis is highest and can be most reliably detected in the early morning and post-dinner urine. Recommendations can be given regarding precise time of the day for measuring ketone bodies in urine in future studies with KDs.

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Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men

Abstract: The isocaloric KD was not accompanied by increased body fat loss but was associated with relatively small increases in EE that were near the limits of detection with the use of state-of-the-art technology. This trial was registered at clinicaltrials.gov as NCT01967563.

Cited by 265 publications

References 47 publications

Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes

Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes

Is There an Optimal Diet for Weight Management and Metabolic Health?

Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?

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