Dietary carbohydrate restriction augments weight loss-induced improvements in glycaemic control and liver fat in individuals with type 2 diabetes: a randomised controlled trial.

Autor: Thomsen MN; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark. mads.norvin.thomsen@regionh.dk., Skytte MJ; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark., Samkani A; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark., Carl MH; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark., Weber P; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark., Astrup A; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark., Chabanova E; Department of Radiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark., Fenger M; Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark., Frystyk J; Department of Endocrinology, Odense University Hospital, Odense, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Hartmann B; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark., Holst JJ; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark., Larsen TM; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark., Madsbad S; Department of Endocrinology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark., Magkos F; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark., Thomsen HS; Department of Radiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark., Haugaard SB; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark., Krarup T; Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Diabetologia [Diabetologia] 2022 Mar; Vol. 65 (3), pp. 506-517. Date of Electronic Publication: 2022 Jan 07.
DOI: 10.1007/s00125-021-05628-8
Abstrakt: Aims/hypothesis: Lifestyle modification and weight loss are cornerstones of type 2 diabetes management. However, carbohydrate restriction may have weight-independent beneficial effects on glycaemic control. This has been difficult to demonstrate because low-carbohydrate diets readily decrease body weight. We hypothesised that carbohydrate restriction enhances the beneficial metabolic effects of weight loss in type 2 diabetes.
Methods: This open-label, parallel RCT included adults with type 2 diabetes, HbA 1c 48-97 mmol/mol (6.5-11%), BMI >25 kg/m 2 , eGFR >30 ml min -1 [1.73 m] -2 and glucose-lowering therapy restricted to metformin or dipeptidyl peptidase-4 inhibitors. Participants were randomised by a third party and assigned to 6 weeks of energy restriction (all foods were provided) aiming at ~6% weight loss with either a carbohydrate-reduced high-protein diet (CRHP, percentage of total energy intake [E%]: CH30/P30/F40) or a conventional diabetes diet (CD, E%: CH50/P17/F33). Fasting blood samples, continuous glucose monitoring and magnetic resonance spectroscopy were used to assess glycaemic control, lipid metabolism and intrahepatic fat. Change in HbA 1c was the primary outcome; changes in circulating and intrahepatic triacylglycerol were secondary outcomes. Data were collected at Copenhagen University Hospital (Bispebjerg and Herlev).
Results: Seventy-two adults (CD 36, CRHP 36, all white, 38 male sex) with type 2 diabetes (mean duration 8 years, mean HbA 1c 57 mmol/mol [7.4%]) and mean BMI of 33 kg/m 2 were enrolled, of which 67 (CD 33, CRHP 34) completed the study. Body weight decreased by 5.8 kg (5.9%) in both groups after 6 weeks. Compared with the CD diet, the CRHP diet further reduced HbA 1c (mean [95% CI] -1.9 [-3.5, -0.3] mmol/mol [-0.18 (-0.32, -0.03)%], p = 0.018) and diurnal mean glucose (mean [95% CI] -0.8 [-1.2, -0.4] mmol/l, p < 0.001), stabilised glucose excursions by reducing glucose CV (mean [95% CI] -4.1 [-5.9, -2.2]%, p < 0.001), and augmented the reductions in fasting triacylglycerol concentration (by mean [95% CI] -18 [-29, -6]%, p < 0.01) and liver fat content (by mean [95% CI] -26 [-45, 0]%, p = 0.051). However, pancreatic fat content was decreased to a lesser extent by the CRHP than the CD diet (mean [95% CI] 33 [7, 65]%, p = 0.010). Fasting glucose, insulin, HOMA2-IR and cholesterol concentrations (total, LDL and HDL) were reduced significantly and similarly by both diets.
Conclusions/interpretation: Moderate carbohydrate restriction for 6 weeks modestly improved glycaemic control, and decreased circulating and intrahepatic triacylglycerol levels beyond the effects of weight loss itself compared with a CD diet in individuals with type 2 diabetes. Concurrent differences in protein and fat intakes, and the quality of dietary macronutrients, may have contributed to these results and should be explored in future studies.
Trial Registration: ClinicalTrials.gov NCT03814694.
Funding: The study was funded by Arla Foods amba, The Danish Dairy Research Foundation, and Copenhagen University Hospital Bispebjerg Frederiksberg.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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