title: Weight loss maintenance in overweight subjects on ad libitum diets with high or low protein content and glycemic index: the DIOGENES trial 12-month results.
abstract: BACKGROUND
  A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce.
  
  
  OBJECTIVE
  The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year.
  
  
  METHODS
  After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27 kg m(-)(2)) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period.
  
  
  RESULTS
  During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0-4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups.
  
  
  CONCLUSIONS
  A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months.
authors.affiliation: Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: E E J G
authors.initials: EE
authors.lastname: Aller
authors.affiliation: Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: T M
authors.initials: TM
authors.lastname: Larsen
authors.affiliation: Institute of Preventive Medicine, Centre for Health and Society, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Claus
authors.affiliation: MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Lindroos
authors.affiliation: Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Kafatos
authors.affiliation: Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuhetal, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Pfeiffer
authors.affiliation: 1] Department of Physiology and Nutrition, University of Navarra, Pamplona, Spain [2] CIBERObn, Instituto Carlos III, Madrid, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Martinez
authors.affiliation: National Multiprofile Transport Hospital, Sofia, Bulgaria.
authors.forename: T
authors.initials: T
authors.lastname: Handjieva-Darlenska
authors.affiliation: Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Kunesova
authors.affiliation: Department of Clinical Biochemistry, Gentofte University Hospital, Hellerup, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Stender
authors.affiliation: Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: W H M
authors.initials: WH
authors.lastname: Saris
authors.affiliation: Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Astrup
authors.affiliation: Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: van Baak
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D031204:Caloric Restriction; D018753:Diet, Protein-Restricted; D004038:Diet, Reducing; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005060:Europe / Q000453:epidemiology; D005190:Family; D005260:Female; D005951:Glucose Tolerance Test; D038321:Glycemic Index; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D009765:Obesity / Q000517:prevention & control / Q000628:therapy*; D010349:Patient Compliance; D013997:Time Factors; D055105:Waist Circumference; D015430:Weight Gain; D015431:Weight Loss; D044465:White People
chemical_list: D004040:Dietary Carbohydrates; D004044:Dietary Proteins