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Body weight and metabolic risk factors in patients with type 2 diabetes on a self-selected high-protein low-carbohydrate diet

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Abstract

Purpose

We previously reported beneficial glucoregulatory effects of a fully provided carbohydrate-reduced, high-protein (CRHP) diet in patients with type 2 diabetes mellitus (T2DM) in a crossover 2 × 6-week trial, in which patients maintained their body weight. Here, we investigated physiological changes during an additional 6-month period on a self-selected and self-prepared CRHP diet.

Methods

Twenty-eight patients with T2DM were instructed to consume a CRHP diet (30% of energy from carbohydrate and 30% from protein) for 24 weeks, after an initial 2 × 6-week trial when all food was prepared and provided to them. Patients received dietary advice every 2 weeks. At weeks 0, 6, 12 and 36, they underwent a 3-h intravenous glucose tolerance test, a 4-h mixed meal test, and a 48-h continuous glucose monitoring. Liver, muscle, pancreas, and visceral fat contents were measured by magnetic resonance imaging.

Results

During the 24-week self-selected diet period (weeks 12–36), body weight, visceral fat, liver fat, and glycated haemoglobin were maintained at the same levels achieved at the end of the fully provided diet period, and were still lower than at baseline (P < 0.05). Postprandial insulinaemia and insulin secretion were significantly greater (P < 0.05). At week 36, fasting insulin and C-peptide levels increased (P < 0.01) and daily glycaemia decreased further (P < 0.05) when compared with the end of the fully provided diet period.

Conclusion

Substituting dietary carbohydrate for protein and fat has metabolic benefits in patients with T2DM. These beneficial effects are maintained or augmented over the next 6 months when patients self-select and self-prepare this diet in a dietitian-supported setting.

Trial registration

ClinicalTrials.gov NCT02764021.

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Abbreviations

T2DM:

Type 2 diabetes mellitus

EASD:

European Association for the Study of Diabetes

CRHP:

Carbohydrate-reduced high-protein

HbA1c:

Glycated haemoglobin

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Acknowledgements

We thank the participants for their time and effort, and their commitment to make this study successful. Moreover, we thank the kitchen staff and the dietitians of the Department of Nutrition, Exercise and Sports (NEXS) at the University of Copenhagen for their preparing the test diets and monitoring the participants.

Funding

The study was funded by grants from Arla Food for Health; the Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen; the Department of Clinical Medicine, Aarhus University; the Department of Nutrition, Exercise and Sports and the Department of Biomedical Sciences, University of Copenhagen; the Copenhagen University Hospital, Bispebjerg; and a fund from The University of Jeddah, Jeddah, Saudi Arabia. Arla Foods, JAN Import A/S, Royal Greenland and Danish Crown contributed with ingredients included in the study meal production.

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Authors and Affiliations

  1. Department of Nutrition, Exercise and Sports, Københavns Universitet, Copenhagen, Denmark

    Ahmad H. Alzahrani, Arne Astrup, Christian Ritz, Thure Krarup, Thomas Meinert Larsen & Faidon Magkos

  2. Department of Physiology, Faculty of Medicine, The University of Jeddah, Jeddah, Saudi Arabia

    Ahmad H. Alzahrani

  3. Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark

    Mads J. Skytte, Amirsalar Samkani, Mads N. Thomsen, Steen B. Haugaard & Thure Krarup

  4. Department of Radiology, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark

    Elizaveta Chabanova & Henrik S. Thomsen

  5. Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark

    Jan Frystyk

  6. The Research Unit for Endocrinology, Department of Endocrinology, Odense University Hospital, Odense, Denmark

    Jan Frystyk

  7. Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

    Jens J. Holst & Sten Madsbad

  8. Department of Internal Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark

    Sten Madsbad & Steen B. Haugaard

  9. Department of Nutrition, Exercise and Sports, Københavns Universitet, Rolighedsvej 26, 1958, Frederiksberg C, Denmark

    Faidon Magkos

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  1. Ahmad H. Alzahrani
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  2. Mads J. Skytte
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  3. Amirsalar Samkani
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  5. Arne Astrup
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Corresponding author

Correspondence to Faidon Magkos.

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Conflict of interest

Arne Astrup is currently employed by The Novo Nordisk Foundation to establish a National Centre for Healthy Weight, and is member of the advisory board or serves as consultant for: Gelesis, USA; Groupe Éthique et Santé, France; and Weight Watchers, USA. He is co-owner and member of the board of the Danish consultancy companies Dentacom Aps, Flaxslim ApS, and Personalized Weight Management Research Consortium ApS; and co-inventor of a number of patents owned by the University of Copenhagen in accordance with Danish law. Thomas Meinert Larsen is advisor for the “Sense” diet program. The remaining authors have no conflicts of interest to declare.

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Alzahrani, A.H., Skytte, M.J., Samkani, A. et al. Body weight and metabolic risk factors in patients with type 2 diabetes on a self-selected high-protein low-carbohydrate diet. Eur J Nutr 60, 4473–4482 (2021). https://doi.org/10.1007/s00394-021-02605-0

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