Alterations in the macronutrient content of the diet and the effects on body composition, cardiovascular disease risk and the control of energy metabolism in obese patients with type 2 diabetes mellitus.
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Background/Objective: Several studies have shown that a low carbohydrate diet (LCHOD) can improve glycaemic control in type 2 diabetes (T2DM). The objective of the current study was to compare two ways of administration of a LCHOD: self-prepared meals versus ready-made meals, and their effects on weight loss, glycaemic control, body composition, cardiovascular risk and resting metabolic rate over 12 months. Research design and methods: Forty-one volunteers with the mean body mass index of 38.8 kg/m2 and poorly controlled T2DM (glycosylated haemoglobin, HbA1c > 7.5%) were randomized to either protein sparing modified fast (< 40g of carbohydrate daily, self-cooked; PSMF) or Go Lower (readymade meals; GL) diet. Both groups received multivitamin supplementation and attended monthly visits. The main outcome was weight loss and its composition. Results: Fourteen (34 %) participants completed 12 months of the intervention. There were no differences in the weight or any other changes between the diet groups at 12 months. Overall, body mass and fat mass decreased (-5.5 ± 7.3 kg, P < 0.001 and -5.1 ± 6.7 kg, P < 0.001 respectively) but fat free mass did not change. There was an overall reduction in HbA1c (-0.4 ± 1.1 %, P < 0.001), increase in HDL-cholesterol (+0.07 ± 0.18 mmol/L, P < 0.001) and decrease in triacylglycerol (-0.6 ± 2.4 mmol/L, P = 0.014). Resting metabolic rate significantly decreased (-137 ± 265 kcal/d, P < 0.001). Conclusion: LCHOD, independently of the approach taken, led to weight loss and improvements in glycaemic control in obese volunteers with poorly controlled T2DM. The results confirm that lifestyle modification using LCHOD is effective for improving T2DM and suggest that the type of approach to the diet can be matched to an individual’s preferences.