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Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.ORCID iD: 0000-0002-2432-3846
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology. (Diabetes Research Centre)
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
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2014 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 106, no 2, 221-227 p.Article in journal (Refereed) Published
Abstract [en]

Aims

To compare the effects on health-related quality of life (HRQoL) of a 2-year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD) based on four group-meetings to achieve compliance. To describe different aspects of taking part in the intervention following the LFD or LCD.

Methods

Prospective, randomized trial of 61 adults with Type 2 diabetes mellitus. The SF-36 questionnaire was used at baseline, 6, 12 and 24 months. Patients on LFD aimed for 55–60 energy percent (E%) and those on LCD for 20 E% from carbohydrates. The patients were interviewed about their experiences of the intervention.

Results

Mean body-mass-index was 32.7 ± 5.4 kg/m2 at baseline. Weight-loss did not differ between groups and was maximal at 6 months, LFD: −3.99 ± 4.1 kg, LCD: −4.31 ± 3.6 kg (p < 0.001 within groups). There was an increase in the physical component score of SF-36 from 44.1 (10.0) to 46.7 (10.5) at 12 months in the LCD group (p < 0.009) while no change occurred in the LFD group (p < 0.03 between groups). At 12 months the physical function, bodily pain and general health scores improved within the LCD group (p values 0.042–0.009) while there was no change within the LFD group.

Conclusions

Weight-changes did not differ between the diet groups while improvements in HRQoL only occurred after one year during treatment with LCD. No changes of HRQoL occurred in the LFD group in spite of a similar reduction in body weight.

 

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 106, no 2, 221-227 p.
Keyword [en]
Type 2 diabetes mellitus; Dietary intervention; Low-carbohydrate diet; SF-36
National Category
Clinical Medicine Basic Medicine
Identifiers
URN: urn:nbn:se:liu:diva-112690DOI: 10.1016/j.diabres.2014.08.032ISI: 000346060500019PubMedID: 25271116OAI: oai:DiVA.org:liu-112690DiVA: diva2:769560
Available from: 2014-12-08 Created: 2014-12-08 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Trials of Diets for Treatment of Diabetes: A comparison of diets for treatment of type 2 diabetes, aspects on long and short term effects
Open this publication in new window or tab >>Trials of Diets for Treatment of Diabetes: A comparison of diets for treatment of type 2 diabetes, aspects on long and short term effects
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients.

Methods

A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed.

To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed.

Results

There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only.

In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP).

Conclusions

In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative.

In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 48 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1441
Keyword
Dietary intervention, type 2 diabetes, low-carbohydrate diet, blood glucose, blood lipids, insulin, body mass index, quality of life, inflammation, cytokine
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-116691 (URN)10.3384/diss.diva-116691 (DOI)978-91-7519-140-9 (ISBN)
Public defence
2015-05-13, Linden, Ingång 65, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2015-04-01Bibliographically approved

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Guldbrand, HansLindström, TorbjörnÖstgren, Carl JohanNyström, Fredrik H.Bachrach-Lindström, Margareta

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