Long term weight maintenance after advice to consume low carbohydrate, higher protein diets--a systematic review and meta analysis.
BACKGROUND
Meta analysis of short term trials indicates that a higher protein, lower carbohydrate weight loss diet enhances fat mass loss and limits lean mass loss compared with a normal protein weight loss diet. Whether this benefit persists long term is not clear.


RESULTS
We selected weight loss studies in adults with at least a 12 month follow up in which a higher percentage protein/lower carbohydrate diet was either planned or would be expected for either weight loss or weight maintenance. Studies were selected regardless of the success of the advice but difference in absolute and percentage protein intake at 12 months was used as a moderator in the analysis. Data was analysed using Comprehensive Meta analysis V2 using a random effects analysis. As many as 32 studies with 3492 individuals were analysed with data on fat and lean mass, glucose and insulin from 18 to 22 studies and lipids from 28 studies. A recommendation to consume a lower carbohydrate, higher protein diet in mostly short term intensive interventions with long term follow up was associated with better weight and fat loss but the effect size was small-standardised means of 0.14 and 0.22, p = 0.008 and p < 0.001 respectively (equivalent to 0.4 kg for both). A difference of 5% or greater in percentage protein between diets at 12 mo was associated with a 3 fold greater effect size compared with <5% (p = 0.038) in fat mass (0.9 vs. 0.3 kg). Fasting triglyceride and insulin were also lower with high protein diets with effect sizes of 0.17 and 0.22, p = 0.003 and p = 0.042 respectively. Other lipids and glucose were not different.


CONCLUSIONS
The short term benefit of higher protein diets appears to persist to a small degree long term. Benefits are greater with better compliance to the diet.
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia. Electronic address: peter.clifton@unisa.edu.au.
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Clifton
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia; Flinders University, Bedford Park, Adelaide, Australia.
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Condo
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia.
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Keogh
D050154:Adiposity; D001786:Blood Glucose; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D004038:Diet, Reducing; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D009765:Obesity / Q000178:diet therapy*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D007328:Insulin; D008055:Lipids; D002097:C-Reactive Protein
Carbohydrate; Percentage protein; Protein; Weight loss