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  1. High protein diet and weight loss 12/21 實習學生:周少鼎 指導老師:彭惠鈺 1

  2. Background In response to the obesity epidemic, there has been increased public interest and use of alternative weight-loss diet that contravene conventional dietary guidelines. (ex: atkines diet, zone diet ..etc) 2

  3. Background Popular alternatives include high-protein diets, which have a common theme of restricting carbohydrate intake while increasing protein. Side effect? Effect? Safety? 3

  4. Background • A high-protein diet with resistance exercise training improves weight lossand body composition in overweight and obese patients with type 2 diabetes. • Long-term effect of a high-protein weight-loss diet. • Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.

  5. A High-Protein Diet With ResistanceExercise Training Improves Weight Lossand Body Composition in Overweight andObese Patients With Type 2 Diabetes. Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. Diabetes Care 33:969-976, 2010 5

  6. Research design and methods Questionnaires received (n=126) Eligible for participation (n=82) randomized CON diet n=19 HP diet n=21 CON diet +RT n=22 HP diet +RT n=20 16 weeks CON diet n=16 HP diet n=12 CON diet +RT n=17 HP diet +RT n=14

  7. Research design and methods Participants information • BMI:35.3±4.5 kg/m2 • Age:55.0±8.4 • Type 2 DM (without using insulin) • No specific diseases • Lack of regular exercise habit

  8. Research design and methods Diet intervention Exercise intervention Con diet High protein diet ♀:~1428kcal/day ♂:~1666kcal/day CHO:53% Protein:19% (~0.7 kg/day) Fat:26% CHO:43% Protein:33% (~1.2 kg/day) Fat:22% 3 nonconsecutive days /week 8 separate exercise /day 2 sets /per exercise 8-12 repetitions/set rest between two set:1-2min every 2 weeks consult qualified dietitian 7 consecutive days diet record

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

  10. Result 10

  11. Result 11

  12. Result 12

  13. Result 13

  14. Result 14

  15. Discussion • Although previous studies have observed protective effects of RT and HP diets on FFM during caloric restriction, these effects have not been consistently shown. (protein 1.12g kg/day) Diabetes care 2002;25:431-438,2002;25:425-430 Metabolism 1994;43:1481-1487 • The previous studies showed that the degree of FFM retention during weight loss increases with increasing quartiles of protein intake. (protein ≥ 1.4g kg/day) Am J Clin Nutr 2006;83:260-274 15

  16. Conclusion the Participants in RT produced greater weight and fat loss and increase in muscular strength compared with energy restriction alone. Additionally, replacement of some carbohydrate for protein further magnified these effects, resulting in greatest reductions in weight, fat mass, WC, and insulin. All treatment had similar improvements in glycemic control and CVD risk. 16

  17. Long-term effect of a high-protein weight-loss diet. Clifton PM, Keogh JB, Noakes M. Am J Clin Nutr. 2008 Jan;87:23-29. 17

  18. Research design and methods Eligible for participation (n=133) women Randomization (n=119) LP diet n=58 HP diet n=61 64 weeks LP diet n=38 HP diet n=41

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

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

  21. Result CON diet n=38 HP diet n=41 Participant with diet record (n=73) RLP n=46 RHP n=27 The prescription for protein in the original study was 110 g/d. We defined compliance at 80% of this original prescription and found that this was the top tertile of reported protein intake

  22. Result 22

  23. Result 23

  24. Result 24

  25. Result 25

  26. Result 26

  27. Conclusion A higher protein intake appears to confer some weight-loss benefit after 64 week. Overall, cardiovascular disease risk markers improved, but protein intake per se did not appear to confer any extra benefit. 27

  28. Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet. Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Journal of the American Dietetic Association Volume 110, Issue 4, April 2010, Pages 633–638 28

  29. Research design and methods Eligible for participation (n=122) Randomization (n=118) Very-low-carbohydrate, high-fat diet n=57 High-carbohydrate, low-fat diet n=61 1 year Very-low-carbohydrate, high-fat diet n=33 High-carbohydrate, low-fat diet n=35

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

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

  32. Result MDRD equation: (eGFR) (mL/min/1.73 m2)=186.3(serumcreatinine [mg/dL])1.154*(age)0.203*0.742 (if female). Salazar and Corcoran equation : For men: eGFR(mL/min)=(137-age)*[(0.285*weight)+(12.1*height2)]/(51*creatinine concentration) for women: eGFR (mL/min)(146-age)*[(0.287*weight)+(9.74*height2)]/(60*creatinine concentration) 32

  33. Discussion Chronic consumption of a very-low-carbohydrate diet (high protein) may affect kidney function by increasing glomerular pressure and hyperfiltration that may lead to progressive loss of renal function Nutr Rev. 2002;60:189-200. Obes Rev. 2005;6:235-245. In this study, the original hypothesis that a very-low-carbohydrate diet would adversely affect renal function was not supported. obesity time 33

  34. Conclusion In people with abdominal obesity and normal renal function, consumption of a very-low-carbohydrate high-fat weight loss diet for 52 week does not adversely affect renal function compared with a conventional high carbohydrate, low-fat diet. 34

  35. 總結 35

  36. 總結 綜觀短期與長期的影響,對於肥胖與腎功能正常的病人來說,高蛋白飲食相較於一般飲食減重可以減少肌肉的流失與增加體脂肪的消耗。 根據研究指出,在64個星期內,高蛋白飲食(35% protein)不會增加腎的負擔。 高蛋白飲食搭配阻力訓練可以達到更顯著的減重效果。 36

  37. 總結 37

  38. 總結 38

  39. 總結 39

  40. Thank you for attention