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Rodrigo-Carbo C, Madinaveitia-Nisarre L, Perez-Calahorra S, et al. Low-calorie, high-protein diets, regardless of protein source, improve glucose metabolism and cardiometabolic profiles in subjects with prediabetes or type 2 diabetes and overweight or obesity. Diabetes Obes Metab. 2024 Oct 17. doi: 10.1111/dom.16013. (Original study)
Abstract

AIM: The aim was to study the effect of two low-calorie, high-protein (HP) diets, with most of the protein coming from animal or plant sources, on glycaemic and other cardiometabolic outcomes in subjects with overweight or obesity and glucose metabolism disorders.

MATERIALS AND METHODS: A total of 117 participants aged >18 years with body mass index over 27.5 kg/m2 and prediabetes or type 2 diabetes mellitus (T2DM) were randomized to one of two HP low-calorie diets (35% of total calories from protein), in which 75% of the protein was from either plant-based sources (HPP) or animal sources (HPA). For both diets, 30% and 35% of the total calories were from fat and carbohydrates, respectively. The dietary intervention lasted 6 months.

RESULTS: Both diets improved body composition to a similar extent, including weight loss (-8.05 ± 5.12 kg for the HPA diet and -7.70 ± 5.47 kg for the HPP diet at 6 months) and fat mass, mainly visceral fat. Both diets had a similar beneficial effect on glucose metabolism, including fasting glucose, insulin, homeostasis model assessment of insulin resistance index and glycated haemoglobin. Other biochemical parameters, including lipid profiles, liver enzymes, adipokines and inflammatory biomarkers, similarly improved in both groups. Fasting incretins, mainly glucagon-like peptide 1, decreased significantly in both groups, and this effect correlated with weight loss.

CONCLUSIONS: Low-calorie HP diets improved body composition, glucose metabolism and other cardiometabolic outcomes, regardless of protein source (either animal or plant sources), in outpatients with prediabetes or T2DM.

CLINICAL TRIAL REGISTRATION: The clinical trial was registered in ClinicalTrials.gov (identifier: NCT05456347) https://clinicaltrials.gov/study/NCT05456347?term=NCT05456347&rank=1.

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Comments from MORE raters

Physician rater

Impressive findings. Larger sample sizes and longer duration trials to confirm are needed.

Physician rater

Useful information. The weight loss and improvement in metabolic factors provide encouragement to recommend a higher protein/lower carb diet that does not go as far as a ketogenic diet.

Physician rater

Insulin resistance estimated via HOMA-IR only; clamp studies would have been preferable. The existing literature that is directly related is incompletely discussed, which influences the conclusions in this study.

Physician rater

This study shows that increased protein, regardless of source, is not detrimental. I am not sure, however, that the benefits the authors attribute to these diets have anything to do with the increased protein, but rather with the 30% fewer calories in the diet.

Physician rater

This study showed that energy-efficient high protein diets can statistically significantly improve glucose homeostasis among adults.
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