Article

Effects of dietary composition on energy expenditure during weight-loss maintenance.

New Balance Foundation Obesity Prevention Center, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
JAMA The Journal of the American Medical Association (impact factor: 30.03). 06/2012; 307(24):2627-34. DOI:10.1001/jama.2012.6607
Source: PubMed

ABSTRACT Reduced energy expenditure following weight loss is thought to contribute to weight gain. However, the effect of dietary composition on energy expenditure during weight-loss maintenance has not been studied.
To examine the effects of 3 diets differing widely in macronutrient composition and glycemic load on energy expenditure following weight loss.
A controlled 3-way crossover design involving 21 overweight and obese young adults conducted at Children's Hospital Boston and Brigham and Women's Hospital, Boston, Massachusetts, between June 16, 2006, and June 21, 2010, with recruitment by newspaper advertisements and postings.
After achieving 10% to 15% weight loss while consuming a run-in diet, participants consumed an isocaloric low-fat diet (60% of energy from carbohydrate, 20% from fat, 20% from protein; high glycemic load), low-glycemic index diet (40% from carbohydrate, 40% from fat, and 20% from protein; moderate glycemic load), and very low-carbohydrate diet (10% from carbohydrate, 60% from fat, and 30% from protein; low glycemic load) in random order, each for 4 weeks.
Primary outcome was resting energy expenditure (REE), with secondary outcomes of total energy expenditure (TEE), hormone levels, and metabolic syndrome components.
Compared with the pre-weight-loss baseline, the decrease in REE was greatest with the low-fat diet (mean [95% CI], -205 [-265 to -144] kcal/d), intermediate with the low-glycemic index diet (-166 [-227 to -106] kcal/d), and least with the very low-carbohydrate diet (-138 [-198 to -77] kcal/d; overall P = .03; P for trend by glycemic load = .009). The decrease in TEE showed a similar pattern (mean [95% CI], -423 [-606 to -239] kcal/d; -297 [-479 to -115] kcal/d; and -97 [-281 to 86] kcal/d, respectively; overall P = .003; P for trend by glycemic load < .001). Hormone levels and metabolic syndrome components also varied during weight maintenance by diet (leptin, P < .001; 24-hour urinary cortisol, P = .005; indexes of peripheral [P = .02] and hepatic [P = .03] insulin sensitivity; high-density lipoprotein [HDL] cholesterol, P < .001; non-HDL cholesterol, P < .001; triglycerides, P < .001; plasminogen activator inhibitor 1, P for trend = .04; and C-reactive protein, P for trend = .05), but no consistent favorable pattern emerged.
Among overweight and obese young adults compared with pre-weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low-glycemic index diet, and least with the very low-carbohydrate diet.
clinicaltrials.gov Identifier: NCT00315354.

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Keywords

15% weight loss
 
21 overweight
 
24-hour urinary cortisol
 
3 diets
 
Children's Hospital Boston
 
dietary composition
 
energy expenditure
 
glycemic load
 
high-density lipoprotein [HDL] cholesterol
 
isocaloric low-fat diet
 
low glycemic load
 
low-carbohydrate diet
 
low-fat diet
 
low-glycemic index diet
 
moderate glycemic load
 
pre-weight-loss baseline
 
pre-weight-loss energy expenditure
 
Reduced energy expenditure
 
total energy expenditure
 
weight loss