Pretreatment Fasting Glucose and Insulin as Determinants of Weight Loss on Diets Varying in Macronutrients and Dietary Fibers-The POUNDS LOST Study.

Mads Hjorth,Catherine Champagne,Yishai Zohar,Donald Williamson,Jennifer Rood,George Bray,Frank Sacks,Donna Ryan,Lorien Urban,Derek Miketinas,Arne Astrup

doi:10.3390/nu11030586

Abstract

Efforts to identify a preferable diet for weight management based on macronutrient composition have largely failed, but recent evidence suggests that satiety effects of carbohydrates may depend on the individual’s insulin-mediated cellular glucose uptake. Therefore, using data from the POUNDS LOST trial, pre-treatment fasting plasma glucose (FPG), fasting insulin (FI), and homeostatic model assessment of insulin resistance (HOMA-IR) were studied as prognostic markers of long-term weight loss in four diets differing in carbohydrate, fat, and protein content, while assessing the role of dietary fiber intake. Subjects with FPG <100 mg/dL lost 2.6 (95% CI 0.9;4.4, p = 0.003) kg more on the low-fat/high-protein (n = 132) compared to the low-fat/average-protein diet (n = 136). Subjects with HOMA-IR ≥4 lost 3.6 (95% CI 0.2;7.1, p = 0.038) kg more body weight on the high-fat/high-protein (n = 35) compared to high-fat/average-protein diet (n = 33). Regardless of the randomized diet, subjects with prediabetes and FI below the median lost 5.6 kg (95% CI 0.6;10.6, p = 0.030) more when consuming ≥35 g (n = 15) compared to <35 g dietary fiber/10 MJ (n = 16). Overall, subjects with normal glycemia lost most on the low-fat/high-protein diet, subjects with high HOMA-IR lost most on the high-fat/high protein diet, and subjects with prediabetes and low FI had particular benefit from dietary fiber in the diet.

Highlights

During the past 30 years, there has been a great deal of controversy about the composition of the optimal diet for weight loss and maintenance
We found that subjects with normoglycemia lost the most body weight when randomized to the low-fat/high-protein diet, and that subjects with high homeostatic model assessment of insulin resistance (HOMA-IR) lost the most on the high-fat/high-protein diet
We found that participants with the highest intake of dietary fiber lost more body weight during the 24-month dietary intervention period, which was fasting plasma glucose (FPG)

Summary

Introduction

During the past 30 years, there has been a great deal of controversy about the composition of the optimal diet for weight loss and maintenance. Numerous strategies for modifying carbohydrate intake have been proposed, from ketogenic very-low-carbohydrate diets [4] to diets with increased protein and a lowered glycemic. Efforts to identify a preferable diet for weight loss and weight loss maintenance based on macronutrient composition have largely failed [6], implying that no single diet is ideal for all participants with overweight and obesity [7]. Brain glucose uptake was positively correlated with fullness and satiety [12]. This suggests that whether or not a carbohydrate-rich diet, which, in the case of high glycemic index foods, would result in rapid increases in blood glucose, should be recommended as diets for weight loss and weight loss maintenance depends on the degree to which glucose enters the brain. Carbohydrate-rich meals may, be satiating in insulin-sensitive individuals, but less so in more insulin-resistant individuals

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