A Comparison of the Weight Loss Effect between a Lowcarbohydrate Diet and a Calorie-restricted Diet in
Combination with Intragastric Balloon Therapy
Satoshi Maekawa1, Makoto Niizawa1
1 Nagano Matsushiro General Hospital, Nagano, JapanOBJECTIVESMETHODSRESULTS

Intragastric balloon (IGB) therapy
is a low-invasion treatment forobesity. Recently, a lowcarbohydrate diet has shown
effectiveness for encouraging
weight loss, but whether or not a
low-carbohydrate diet improves
the efficacy of IGB therapy
remains unclear. Therefore, we
examined the effectiveness of alow-carbohydrate diet comparedwith a calorie-restricted diet incombination with IGB therapy.

A prospective study was conducted on 51patients who had undergone IGB therapy fromOctober 2012 to December 2017. Overall, 31of the 51 patients were included in this study(12-month assessment after IGB placement).
These 31 cases consisted of 18 IGB plus lowcarbohydrate diet and 13 IGB plus calorierestricted diet. We compared the two groups
with respect to body weight loss as outcomes.

At 12 months after IGB placement,
the body weight was significantly
lower than that observed atbaseline in both the IGB plus lowcarbohydrate diet group (baseline
101.9 ± 25.8 kg, 12 months 88.2± 21.9 kg) (p<0.0001) and theIGB plus calorie-restricted dietgroup (baseline 103.5 ± 17.0 kg,12 months 89.1 ± 6.2 kg)(p<0.005). The percentage ofexcess weight loss(%EWL) in theIGB plus low-carbohydrate dietgroup was slightly higher than thatin the IGB plus calorie-restricteddiet group, but there was no
significant difference between the2 groups at 12 months after IGB
placement (IGB plus lowcarbohydrate 49.9% ± 60.0%,
IGB plus calorie-restricted diet33.1% ± 27.0%).

Table 1. Characteristics of the Patients at Baseline
IGB plus
Characteristics
low-carbohydrate diet
n=18Age (years)
45.6 ± 12.8
Female sex - no. (%)
11 (61.1)
BH (cm)163.7 ± 8.0
BW (kg)101.9 ± 25.8
2
BMI (kg/m )37.6 ± 7.1
FPG (mg/dl)
107.6 ± 25.3
HbA1C (%)
6.1 ± 0.7
HOMA-IR3.7 ± 2.2
TGs (mg/dl)
116.7 ± 54.6
HDL-C (mg/dl)
52.4 ± 11.4
LDL-C (mg/dl）
128.7 ± 25.9
UA (mg/dl)
6.3 ± 1.1
SBP (mmHg)
136.1 ± 15.6
DBP (mmHg)
85.7 ± 16.0
2VFA (cm )213.0 ± 86.3
2SFA (cm )426.8 ± 189.1
ORD
2.9 ± 1.9
IGB volume (ml)644.4 ± 68.4

Figure 1. Flow diagram of the patients

IGB plus

calorie-restricted dietp value

n=1346.5 ± 13.8
7 (53.8)
165.2 ± 8.7
103.5 ± 17.0
38.0 ± 6.1
103.9 ± 11.4
6.2 ± 0.6
3.7 ± 2.5
128.9 ± 55.1
45.3 ± 11.4
111.1 ± 40.3
6.3 ± 2.4
130.9 ± 17.7
82.8 ± 9.7
249.3 ± 93.6
390.1 ± 185.9
2.2 ± 1.2
653.8 ± 66.0

0.8516
0.6977
0.63220.84610.88830.65550.76270.98480.56590.11100.1556
0.93250.3996
0.56690.27430.59490.30260.7043

Values are the means ± standard deviation. BH: body height, BW: body weight, BMI: body mass index,
FPG: fasting plasma glucose, HbA1c: hemoglobin A1c, HOMA-IR: homeostasis model assessment ofinsulin resistance, TGs: triglycerides, HDL-C: high-density lipoprotein–cholesterol, LDL-C: low-density
lipoprotein–cholesterol, UA: uric acid, SBP: systolic blood pressure, DBP: diastolic blood pressure, VFA:
visceral fat area, SFA: subcutaneous fat area, ORDs：obesity-related diseases.

Figure 2. Changes in %EWL after IGB placement during the 12-month intervention.

Table 2. Efficacy Outcomes
Variable

IGB plus low-carbohydrate dietBaseline
12 months
p value*
101.9 ± 25.8
88.2 ± 21.9 < 0.0001*

BW (kg)
2BMI (kg/m )%EWL (%)
BW rebound - no. (%)
FPG (mg/dl)
HbA1C (%)
HOMA-IRTGs (mg/dl)
HDL-C (mg/dl)
LDL-C (mg/dl）
UA (mg/dl)
SBP (mmHg)
DBP (mmHg)
VFA (cm2)
SFA (cm2)
ORDs

37.6 ± 7.1

p value†

IGB plus calorie-restricted diet
Baseline
12 months
103.5 ± 17.0
89.1 ± 6.2

p value*
0.0025*0.0022*ーー
0.61130.09920.0378*0.38760.20410.34020.59440.0452*0.0032*0.0252*0.91300.35550.0290†0.65550.43080.93100.23010.1616
0.36750.82930.78990.46420.32590.20900.08210.9187
0.6221< 0.0001*

38.0 ± 6.1

ーー
107.6 ± 25.3
6.1 ± 0.7
3.7 ± 2.2
116.7 ± 54.6
52.4 ± 11.4
128.7 ± 25.9
6.3 ± 1.1
136.1 ± 15.6
85.7 ± 16.0
213.0 ± 86.3

32.6 ± 6.3
49.9 ± 60.0
3 (16.7)
100.5 ± 13.2
5.7 ± 0.6
2.6 ± 1.3
88.1 ± 41.0
58.4 ± 14.5
128.6 ± 32.2
5.9 ± 1.2
125.7 ± 15.6
75.2 ± 11.6
141.5 ± 64.6

ーー
0.17380.0165*0.0323*0.0029*0.0123*0.98370.18010.0103*0.0013*0.0002*ーー
103.9 ± 11.4
6.2 ± 0.6
3.7 ± 2.5
128.9 ± 55.1
45.3 ± 11.4
111.1 ± 40.3
6.3 ± 2.4
130.9 ± 17.7
82.8 ± 9.7
249.3 ± 93.6

32.9 ± 3.8
33.1 ± 27.0
7 (53.8)
101.5 ± 14.6
5.9 ± 0.5
2.6 ± 2.2
109.6 ± 53.2
48.8 ± 9.8
116.1 ± 42.4
6.0 ± 1.7
124.1 ± 17.2
72.1 ± 11.8
174.3 ± 117.3

426.8 ± 189.1
2.9 ± 1.9

337.7 ± 186.6
2.3 ± 2.1

0.0094*0.0370*390.1 ± 185.9
2.2 ± 1.2330.6 ± 191.8
2.0 ± 1.40.8862*The results were considered significant at p <0.05 for within-group comparisons.
†The results were considered significant at p <0.05 for between-group comparisons.
Values are the means ± standard deviation.
%EWL; [weight loss / (initial weight – weight at BMI 25)] ×100.
The BW (body weight) rebound was defined when the value of %EWL (6 months) – %EWL (12 months) was more than 10%

Table 3. Nutrition Intake at 12 Months
IGB plus low-carbohydrate dietIntakeIGB plus calorie-restricted dietp value*Energy ratio (%)

IntakeEnergy ratio (%)

Calorie intake (kcal) 1550.0 ± 146.5

1001523.1 ± 178.7

1000.6486

Calorie intake / IBW

23.2 ± 2.8ー

22.6 ± 3.8ー

0.5615

Carbohydrate (g)103.9 ± 42.0

26.8 ± 10.4

201.2 ± 35.4

52.9 ± 7.0< 0.0001*

Protein (g)91.7 ± 25.7

23.6 ± 5.7

66.2 ± 14.2

17.3 ± 2.60.0009*

Fat (g)76.1 ± 11.1

44.3 ± 5.7

49.2 ± 13.1

28.9 ± 6.0< 0.0001**The results were considered significant at p <0.05 for between-group comparisons.
Values are means ± standard deviation. IBW: ideal body weight.

CONCLUSION
Our study demonstrated that both a low-carbohydrate diet and acalorie-restricted diet were effective interventions for weight
reduction in combination with IGB therapy.

REFERENCES
1. A Comparison of the Weight Loss Effect between a Lowcarbohydrate Diet and a Calorie-restricted Diet in Combination
with Intragastric Balloon Therapy. Intern Med 59:1133-1139,
2020.