Very low energy, meal replacement diets most effective for diabetes remission, weight loss

November 18, 2021

3 min read

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Information: Churuangsuk reports receiving support with a PhD scholarship from Prince of Songkla University, Thailand. Please see the survey for all other authors’ relevant financial information.


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Weight loss programs that include very low-energy diets and formal meal replacements are the most effective for weight loss in type 2 diabetes, according to a systematic review published in Diabetology.

Mike Lean

In a review of 19 meta-analyzes, the researchers also found that programs with a total dietary replacement induction phase were the most effective dietary measure for type 2 diabetes remission, with up to 61% of participants achieving normoglycemia after 1 year.

Churuangsuk is a PhD student in the Department of Human Nutrition at the University of Glasgow.

“All people with type 2 diabetes should be offered a well-planned, professionally supported, structured diet program that is evidence-based, with the goal of achieving and maintaining a weight loss of at least 10 kg.” Mike Lean MA, MB BChir, MD, FRCP, FRSE, professor of human nutrition and consulting physician at the University of Glasgow and an adjunct professor at the University of Otago, Healio said. “It is possible with many diets, and no specific diet has proven better than others. The best results are with a two-phase program that uses a low-calorie induction phase (600-900 kcal / day) with a nutritionally balanced formula diet, unless individuals prefer a food-based approach. This can be successfully delivered in primary care, with attention to drug dose adjustments for glucose lowering and antihypertensive agents. “

Churuangsuk and colleagues identified 21 systematic reviews with 19 meta-analyzes of randomized controlled trials of weight loss diets conducted until May 2021. Researchers synthesized weight loss results, stratified by diet types, and assessed the quality of the meta-analyzes and the safety of the overall results. of each meta-analysis using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Of the 19 meta-analyzes, 18 reported direct comparisons of specific diets. Most meta-analyzes were of critically low (n = 7) to low quality (n = 5); only seven meta-analyzes were rated as high quality.

“Planned analysis of correlations between changes in energy intake and weight changes from baseline, to differentiate effects of energy restrictions and diet regimens, proved impossible based on the published information,” the researchers wrote.

Researchers found that the greatest weight loss was reported with very low energy diets of 400 kcal to 500 kcal per day for 8 to 12 weeks, achieving 6.6 kg greater weight loss than low energy diets of 1,000 kcal to 1,500 kcal per day (95 % CI, -9.5 to -3.7). A high-quality meta-analysis of nine randomized controlled trials reported that replacing one to three main meals daily (13% to 47% total energy) achieved 2.4 kg greater weight loss over 12 to 52 weeks (95% CI –3.3 to –1.4) compared to low-energy diets, according to researchers.

Low carb diets were no better for weight loss than high carb / low fat diets, and the researchers noted that the evidence was of high quality. Diets high in protein, Mediterranean, high-monounsaturated fatty acids, vegetarian, and low glycemic index all achieved minimal or no difference from control diets, although researchers warned that the quality of these studies was low to critically low quality; DEGREES ranged from very low to moderate.

For two randomized controlled trials that assessed type 2 diabetes remission as the primary outcome, the researchers found that compared to usual control arms, programs that included an induction phase with formal total dietary replacement were associated with a median of 54% remission after 12 months. from baseline. Among trials reporting post hoc analyzes for remission, two meal replacements per day for up to 20 weeks and one per day thereafter reported 11% remission after 1 year compared with 2% with standard treatment. A single randomized controlled trial evaluating a Mediterranean diet over 12 months reported a diabetes remission prevalence of 15% compared to 4% in the control arm with a low-fat diet.

For ketogenic / very low carbohydrate and very low energy food-based diets, researchers wrote, the evidence for remission had “severe and critical risk of bias”, with very low DEGREE safety.

“The analyzes contradict some popular claims about specific diets: In particular, ‘low-carb’ diets have no overall benefit for weight loss compared to diets with higher carbohydrates,” Chaitong Churuangsuk, MD, a PhD student in the Department of Human Nutrition at the University of Glasgow, and colleagues wrote .. “However, we can not conclude that an individual with type 2 diabetes in any context will do just as well with any dietary advice, or that a skilled practitioner may not be more successful in advising one type of diet. “

The researchers noted that most of the evidence is limited to 1 year or less, and more research is needed to assess long-term effects on weight, glycemic control, clinical outcomes, and diabetic complications.

“We are actually pretty good at helping people lose enough weight. We need research to show us how we can help more people succeed, ”Lean told Healio. “The great need is to find better ways to help people avoid returning to the eating patterns that made them gain weight and develop type 2 diabetes.”

For more information:

Mike Lean MA, MB BChir, MD, FRCP, FRSE, can be taken on mike.lean@glasgow.ac.uk.

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