Effectiveness of cognitive-behavioral therapy based on the Mediterranean diet for the treatment of obesity. The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Systematic review of interventions in the management of overweight and obese children which include a dietary component Systematic review of interventions in the management of overweight and obese children which include a dietary component. The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary Intervention Randomized Controlled Trial (DIRECT). Effect of a low fat versus a low carbohydrate weight loss dietary intervention on biomarkers of long term survival in breast cancer patients ('CHOICE'): study protocol Study on Lifestyle Intervention and Impaired Glucose Tolerance Maastricht (SLIM): preliminary results after one year Patient freedom to choose a weight loss diet in the treatment of overweight and obesity: a randomized dietary intervention in type 2 diabetes and pre-diabetes Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: the Preventing Overweight Using Novel Dietary Strategies trial. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Effect of Dietary Composition of Weight Loss Diets on High Sensitivity C-Reactive Protein: The Randomized POUNDS LOST Trial A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Impact of a Mediterranean Dietary Pattern and Its Components on Cardiovascular Risk Factors, Glucose Control, and Body Weight in People with Type 2 Diabetes: A Real-Life Study Determinants of weight loss maintenance: a systematic review. Clinical Efficacy of Two Hypocaloric Diets That Vary in Overweight Patients With Type 2 Diabetes The use of technology for delivering a weight loss program for adolescents with intellectual and developmental disabilities. Orlistat in the treatment of overweight or obese Chinese patients with newly diagnosed Type 2 diabetes. A randomized controlled trial of low carbohydrate and low fat/high fiber diets for weight loss. Effect of dietary patterns differing in carbohydrate and fat content on blood lipid and glucose profiles based on weight-loss success of breast-cancer survivors
OBJECTIVE The Mediterranean dietary pattern improves cardiovascular disease factors . More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss . The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss . METHODS A total of 1406 obese subjects ( body mass index , 31+/-5kg/m(2 ) ) , aged 20 - 65 y , from a Mediterranean area in southeast Spain were subjected to a  weight-reduction program . To evaluate effectiveness , weight loss , body fat distribution , biochemical variables , blood pressure changes , mean duration of treatment , percentage of attrition , and the ability to fulfill a Mediterranean diet pattern were assessed . To determine the main barriers to losing weight , a " Barriers to Weight Loss " checklist was completed . RESULTS The behavioral therapy program was effective for the treatment of obesity . The average weight loss was 7.7 kg . The duration of treatment was 34 wk . Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program , and all the variables studied were significantly improved . Attrition was 4 - 9 % , with the main reason being stress ( 37 % ) . Main obstacles to weight loss were " losing motivation , " being " prone to stress-related eating , " and being liable to eat when bored . Recording food intake and assisting group therapy were also important tools for losing weight ( P < or = 0.05 ) . CONCLUSIONS Dietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice . Nutrition professionals should encourage their patients to record food intake and to attend group therapy Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity‐related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE‐ MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non‐r and omised trials . Meta‐analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow‐up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric  overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet‐specific outcomes need to be reported in order to inform best practice Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity-related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE- MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non-r and omised trials . Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice Aims /hypothesisShort-term dietary studies suggest that high-protein diets can enhance weight loss and improve glycaemic control in people with type 2 diabetes . However , the long-term effects of such diets are unknown . The aim of this study was to determine whether high-protein diets are superior to high-carbohydrate diets for improving glycaemic control in individuals with type 2 diabetes . Methods Overweight/obese individuals ( BMI 27–40 kg/m2 ) with type 2 diabetes ( HbA1c 6.5–10 % ) were recruited for a 12 month , parallel design , dietary intervention trial conducted at a diabetes specialist clinic ( Melbourne , VIC , Australia ) . Of the 108 initially r and omised , 99 received advice  to follow low-fat ( 30 % total energy ) diets that were either high in protein ( 30 % total energy , n = 53 ) or high in carbohydrate ( 55 % total energy , n = 46 ) . Dietary assignment was done by a third party using computer-generated r and om numbers . The primary endpoint was change in HbA1c . Secondary endpoints included changes in weight , lipids , blood pressure , renal function and calcium loss . Study endpoints were assessed blinded to the diet group , but the statistical analysis was performed unblinded . This study used an intention-to-treat model for all participants who received dietary advice . Follow-up visits were encouraged regardless of dietary adherence and last measurements were carried forward for study non-completers . Results Ninety-nine individuals were included in the analysis ( 53 in high protein group , 46 in high carbohydrate group ) . HbA1c decreased in both groups over time , with no significant difference between groups ( mean difference of the change at 12 months ; 0.04 [ 95 % CI −0.37 , 0.46 ] ; p = 0.44 ) . Both groups also demonstrated decreases over time in weight , serum triacylglycerol and total cholesterol , and increases in HDL-cholesterol . No differences in blood pressure , renal function or calcium loss were seen . Conclusions /interpretationThese results suggest that there is no superior long-term metabolic benefit of a high-protein diet over a high-carbohydrate in the management of type 2 diabetes . Trial registration ACTRN12605000063617 ( www.anzctr.org.au ) . Funding This study was funded by a nutritional research grant from Meat and Livestock Australia ( MLA ) . J.E. Shaw is supported by NHMRC Fellowship 586623 Lifestyle changes , in particular reducing energy intake , are the cornerstone of current approaches to weight loss and prevention of type 2 diabetes .  However , there is currently no consensus that one dietary regimen is more effective than another for weight loss ( 1 ) or whether particular diets work better for identifiable groups of individuals . There is evidence , however , to suggest that both insulin resistance and insulin secretion play a role in body weight regulation ( 2–12 ) . Therefore , dietary factors such as the dietary glycemic load ( glycemic load = glycemic index [ GI ] × available carbohydrate amount ) that influence these parameters may theoretically interact with subject-specific characteristics of glucose-insulin dynamics to influence the effect of different hypocaloric diets on weight loss or maintenance ( 13,14 ) . Weight loss studies using the concept of the dietary glycemic index or glycemic load have shown conflicting results for heterogeneous groups of individuals ( 15–21 ) . In a 6-month controlled feeding trial in healthy overweight adults with normal glucose tolerance , we tested the hypothesis that individuals with higher insulin secretion lose more weight when r and omized to a low – glycemic load diet compared with a high – glycemic load diet . This study was performed as part of the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy ( CALERIE ) trial at the Human Nutrition Research Center on Aging at Tufts University with approval from the Tufts-New Engl and Medical Center Human Investigation Review Committee . Written informed consent was obtained from all participants . Healthy women and men aged 24–42 BACKGROUND & AIMS Non-alcoholic fatty liver disease ( NAFLD ) affects up to 30 % of the population and signifies increased risk of liver fibrosis and cirrhosis , type 2 diabetes , and cardiovascular disease . Therapies are limited . Weight loss is of benefit but is difficult to maintain . We aim ed at examining the effect of the Mediterranean diet ( MD ) , a diet high in monounsaturated fatty acids , on steatosis and insulin sensitivity , using gold st and ard techniques . METHODS Twelve non-diabetic subjects ( 6 Females/6 Males ) with biopsy-proven NAFLD were recruited for a r and omised , cross-over 6-week dietary intervention study . All subjects undertook both the MD and a control diet , a low fat-high carbohydrate diet ( LF/HCD ) , in r and om order with a 6-week wash-out period in- between . Insulin sensitivity was determined with a 3-h hyperinsulinemic-euglycemic clamp study and hepatic steatosis was assessed with localized magnetic resonance (1)H spectroscopy ( (1)H-MRS ) . RESULTS At baseline , subjects were abdominally obese with elevated fasting concentrations of glucose , insulin , triglycerides , ALT , and GGT . Insulin sensitivity at baseline was low ( M=2.7 ± 1.0 mg/kg/min(-1 ) ) . Mean weight loss was not different between the two diets ( p=0.22 ) . There was a significant relative reduction in hepatic steatosis after the MD compared with the LF/HCD : 39 ± 4 % versus 7 ± 3 % , as measured by (1)H-MRS ( p=0.012 ) . Insulin sensitivity improved with the MD , whereas after the LF/HCD there was no change ( p=0.03 between diets ) . CONCLUSIONS Even without weight loss , MD reduces liver steatosis and improves insulin sensitivity in an insulin-resistant population with NAFLD , compared to current dietary advice . This diet should be further investigated in subjects with NAFLD Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content Dietary intervention is recognized as a key component in prevention and management of type 2 diabetes ( T2DM ) and the debate persists : which dietary strategy is most effective . In the Dietary Intervention R and omized Controlled Trial ( DIRECT ) 322 moderately obese participants were r and omized for 2 years to one of three diet groups : low-fat , Mediterranean and low-carbohydrate . Differential effects were observed in the sub-group of patients with T2DM at 24 months : participants r and omized to the Mediterranean diet , which had the highest intake of dietary fibers and unsaturated to saturated fat ratio , achieved greater significant improvements in fasting plasma glucose and insulin levels . Patients who were r and omized to the low-carbohydrate diet , which had the minimal intake of carbohydrates , achieved a significant reduction of hemoglobin A1C . Although improvements were observed in all groups , the low-fat diet was likely to be less beneficial in terms of glycemic control and lipid metabolism . Interpretation of results from different studies on dietary strategies may be complex since there is often no consistency in diet compositions , calorie restriction , intensity of intervention , dietary assessment or extent of adherence in the trial . Nevertheless , it seems that low fat restricted calorie diets are effective for weight loss and are associated with some metabolic benefits ; however , some recent trials have shown that low carbohydrate diets are as efficient in inducing weight loss and in some metabolic measures such as serum triglycerides and HDL-cholesterol may be even superior to low fat diets . When addressing the issue of diet quality rather than quantity applying the glycemic index may have some added benefits . Furthermore special features of the Mediterranean diet have apparent additional favorable effects for patients with T2DM Background Weight loss in overweight or obese breast cancer patients is associated with an improved prognosis for long term survival . However , it is not clear whether the macronutrient composition of the chosen weight loss dietary plan imparts further prognostic benefit . A study protocol is presented for a dietary intervention to investigate the effects of weight loss dietary patterns that vary markedly in fat and carbohydrate contents on biomarkers of exposure to metabolic processes that may promote tumorigenesis and that are predictive of long term survival . The study will also determine how much weight must be lost for biomarkers to change in a favorable direction . Methods / Design Approximately 370 overweight or obese postmenopausal breast cancer survivors ( body mass index : 25.0 to 34.9 kg/m2 ) will be accrued and assigned to one of two weight loss intervention programs or a non-intervention control group . The dietary intervention is implemented in a free living population to test the two extremes of popular weight loss dietary patterns : a high carbohydrate , low fat diet versus a low carbohydrate , high fat diet . The effects of these dietary patterns on biomarkers for glucose homeostasis , chronic inflammation , cellular oxidation , and steroid sex hormone metabolism will be measured . Participants will attend 3 screening and dietary education visits , and 7 monthly one-on-one dietary counseling and clinical data measurement visits in addition to 5 group visits in the intervention arms . Participants in the control arm will attend two clinical data measurement visits at baseline and 6 months . The primary outcome is high sensitivity C-reactive protein . Secondary outcomes include interleukin-6 , tumor necrosis factor-α , insulin-like growth factor-1 ( IGF ) , IGF binding protein-3 , 8-isoprostane-F2-alpha , estrone , estradiol , progesterone , sex hormone binding globulin , adiponectin , and leptin . Discussion While clinical data indicate that excess weight for height is associated with poor prognosis for long term survival , little attention is paid to weight control in the clinical management of breast cancer . This study will provide information that can be used to answer important patient questions about the effects of dietary pattern and magnitude of weight loss on long term survival following breast cancer treatment . Clinical Trial Registration AIMS : Important risk factors for the progression from impaired glucose tolerance to type II diabetes mellitus are obesity , diet and physical inactivity . The aim of this study is to evaluate the effect of a lifestyle-intervention programme on glucose tolerance in Dutch subjects with impaired glucose tolerance ( IGT ) . METHODS : A total of 102 subjects were studied , r and omised into two groups . Subjects in the intervention group received regular dietary advice , and were stimulated to lose weight and to increase their physical activity . The control group received only brief information about the beneficial effects of a healthy diet and increased physical activity . Before and after the first year , glucose tolerance was measured and several other measurements were done . RESULTS : Body weight loss after 1 y was higher in the intervention group . The 2-h blood glucose concentration decreased 0.8±0.3 mmol/l in the intervention group and increased 0.2±0.3 mmol/l in the control group ( P<0.05 ) . Body weight loss and increased physical fitness were the most important determinants of improved glucose tolerance and insulin sensitivity . CONCLUSION : A lifestyle-intervention programme according to general recommendations is effective and induces beneficial changes in lifestyle , which improve glucose tolerance in subjects with IGT . Body weight loss and increased physical fitness were the most important determinants of improved glucose tolerance and insulin sensitivity Background Offering the overweight or obese patient the option of choosing from a selection of weight loss diets has not been investigated in type 2 diabetes . The aim of the study was to investigate if the option to choose from , and interchange between a selection of diets ( “ Choice ” ) , as opposed to being prescribed one set diet ( “ No Choice ” ) , improves drop out rates and leads to improved weight loss and cardio-metabolic outcomes . Methods The study was a 12 month , r and omized parallel intervention . A total of 144 volunteers with type 2 diabetes or pre-diabetes and a BMI > 27 were r and omized to “ No Choice ” or “ Choice ” . Those in the No Choice group were placed on a set weight loss diet ( CSIRO ) with no change permitted . Those in the Choice group could choose from , and interchange between , the CSIRO , South Beach or Mediterranean diets . Results There were no differences in attrition rates or weight loss between the “ Choice ” and “ No Choice ” . In a secondary analysis of the intention-to-treat weight loss data with last measured weight carried forward gave a highly significant diet group by time by gender interaction ( p = 0.002 ) with men doing better in the No Choice group overall ( maximum difference “ No Choice “ -2.9 ± 4.6 kg vs. “ Choice”-6.2 kg ± 5.3 kg at 6 months ) and women doing better in the Choice group overall ( maximum difference Choice -3.1 ± 3.7 kg vs. “ No Choice ” -2.0 kg ± 2.6 kg at 6 months ) . Conclusions Men prefer direction in their weight loss advice and do less well with choice . A gender-specific approach is recommended when prescribing weight loss diets . Trial registration anzctr.org.au ACTRN12612000310864 BACKGROUND Glucose-dependent insulinotropic polypeptide [ also known as gastric inhibitory polypeptide ( GIP ) ] and its receptor ( GIPR ) may link overnutrition to obesity , insulin resistance , and type 2 diabetes . A GIPR variant rs2287019 was recently associated with obesity and glucose metabolism . OBJECTIVE We aim ed to examine whether weight-loss diets that vary in fat content may modify the effect of this variant on changes in body weight , fasting glucose , and insulin resistance in the Preventing Overweight Using Novel Dietary Strategies ( POUNDS LOST ) trial . DESIGN We genotyped the GIPR rs2287019 in 737 overweight adults who were r and omly assigned to 1 of 4 weight-loss diets that varied in macronutrient contents for 2 y. We assessed the percentage changes in body weight , fasting glucose , and insulin resistance ( HOMA-IR ) across genotypes by the low-fat and high-fat diets . RESULTS At 6 mo of diet intervention , the T allele of rs2287019 was associated with greater weight loss ( β ± SE : -1.05 ± 0.56 % ; P = 0.06 ) and greater decreases in fasting glucose ( β ± SE : -2.33 ± 0.86 % ; P = 0.006 ) , fasting insulin ( β ± SE : -8.76 ± 4.13 % ; P = 0.03 ) , and HOMA-IR ( β ± SE : -10.52 ± 4.39 % ; P = 0.01 ) in participants who were assigned to low-fat diets , whereas there was no significant genotype effect on changes in these traits in the group assigned to the high-fat diet ( all P > 0.44 ; P-interaction = 0.08 , 0.04 , 0.10 , and 0.07 , respectively ) . After correction for multiple tests ( significant P = 0.008 ) , the genotype effect on changes in fasting glucose remained significant . Sensitivity analysis in white participants showed that the interactions were more evident on changes in insulin and HOMA-IR ( P-interaction < 0.008 ) . CONCLUSION The T allele of GIPR rs2287019 is associated with greater improvement of glucose homeostasis in individuals who choose a low-fat , high-carbohydrate , and high-fiber diet . The POUNDS LOST trial was registered at clinical trials.gov as NCT00072995 OBJECTIVE Effective diabetic management requires reasonable weight control . Previous studies from our laboratory have shown the beneficial effects of a low-carbohydrate ketogenic diet ( LCKD ) in patients with type 2 diabetes after its long term administration . Furthermore , it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects . These studies have indicated that , in addition to decreasing body weight and improving glycemia , LCKD can be effective in decreasing antidiabetic medication dosage . Similar to the LCKD , the conventional low-calorie , high nutritional value diet is also used for weight loss . The purpose of this study was to underst and the beneficial effects of LCKD compared with the low-calorie diet ( LCD ) in improving glycemia . METHODS Three hundred and sixty-three overweight and obese participants were recruited from the Al-Shaab Clinic for a 24-wk diet intervention trial ; 102 of them had type 2 diabetes . The participants were advised to choose LCD or LDKD , depending on their preference . Body weight , body mass index , changes in waist circumference , blood glucose level , changes in hemoglobin and glycosylated hemoglobin , total cholesterol , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , triglycerides , uric acid , urea and creatinine were determined before and at 4 , 8 , 12 , 16 , 20 , and 24 wk after the administration of the LCD or LCKD . The initial dose of some antidiabetic medications was decreased to half and some were discontinued at the beginning of the dietary program in the LCKD group . Dietary counseling and further medication adjustment were done on a biweekly basis . RESULTS The LCD and LCKD had beneficial effects on all the parameters examined . Interestingly , these changes were more significant in subjects who were on the LCKD as compared with those on the LCD . Changes in the level of creatinine were not statistically significant . CONCLUSION This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects . The ketogenic diet appears to improve glycemic control . Therefore , diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels Overweight and obesity are associated with increased high sensitivity C-reactive protein ( hsCRP ) levels . The purpose of this study was to determine if weight loss diets differing in fat , protein , or carbohydrate composition differentially reduce hsCRP . POUNDS ( Preventing Overweight Using Novel Dietary Strategies ) LOST was a two-year trial of overweight and obese adults r and omly allocated to one of four weight loss diets with targeted percentages of energy derived from fat , protein , and carbohydrates ( 20,15,65%;20,25,55%;40,15,45%;40,25,35 % , respectively ) . hsCRP was measured at baseline , 6 , and 24 months among 710 participants , and adiposity as measured by dual X-ray absorptiometry ( N=340 ) or abdominal computed tomography ( N=126 ) was correlated with hsCRP change . At 6 months , hsCRP was reduced in all trial participants by −24.7 % ( IQR + 7%,−50 % ) , weight by −6.7 % ( IQR −3%,−11 % ) , and waist circumference by −6.0 % ( IQR −3%,−10 % ) ( all P<.002 ) , with no significant differences according to dietary composition . The percent change in hsCRP at 6 and 24 months correlated modestly with change in weight , waist circumference , fasting insulin , fasting glucose , HOMA , and most lipid levels . Reductions in hsCRP persisted despite an approximate 50 % regain of weight by 24 months . The percent change in hsCRP at 24 months significantly correlated with changes in total body fat ( r=0.42 ) , total abdominal adiposity ( r=0.52 ) , subcutaneous abdominal adiposity ( r=0.52 ) , visceral adiposity ( r=0.47 ) , and hepatic tissue density ( r=−0.34 ) ( all P<0.0006 ) . In conclusion , weight loss decreased hsCRP by similar magnitude , irrespective of dietary composition . Clinicians concerned about inflammation and cardiovascular risk should recommend weight loss diets most likely to succeed for their patients BACKGROUND The appropriate dietary intervention for overweight persons with type 2 diabetes mellitus ( DM2 ) is unclear . Trials comparing the effectiveness of diets are frequently limited by short follow-up times and high dropout rates . AIM The effects of a low carbohydrate Mediterranean ( LCM ) , a traditional Mediterranean ( TM ) , and the 2003 American Diabetic Association ( ADA ) diet were compared , on health parameters during a 12-month period . METHODS In this 12-month trial , 259 overweight diabetic patients ( mean age 55 years , mean body mass index 31.4 kg/m(2 ) ) were r and omly assigned to one of the three diets . The primary end-points were reduction of fasting plasma glucose , HbA1c and triglyceride ( TG ) levels . RESULTS 194 patients out of 259 ( 74.9 % ) completed follow-up . After 12 months , the mean weight loss for all patients was 8.3 kg : 7.7 kg for ADA , 7.4 kg for TM and 10.1 kg for LCM diets . The reduction in HbA1c was significantly greater in the LCM diet than in the ADA diet ( -2.0 and -1.6 % , respectively , p < 0.022 ) . HDL cholesterol increased ( 0.1 mmol/l + /- 0.02 ) only on the LCM ( p < 0.002 ) . The reduction in serum TG was greater in the LCM ( -1.3 mmol/l ) and TM ( -1.5 mmol/l ) than in the ADA ( -0.7 mmol/l ) , p = 0.001 . CONCLUSIONS An intensive 12-month dietary intervention in a community-based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups . Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control This study evaluates the relation of a Mediterranean dietary pattern and its individual components with the cardiovascular risk factors profile , plasma glucose and body mass index ( BMI ) in people with type 2 diabetes . We studied 2568 participants at 57 diabetes clinics . Diet was assessed with the EPIC ( European Prospect i ve Investigation into Cancer and Nutrition ) question naire , adherence to the Mediterranean diet was evaluated with the  relative Mediterranean diet score ( rMED ) . A high compared to a low score was associated with a better quality of diet and a greater adherence to the nutritional recommendations for diabetes . However , even in the group achieving a high score , only a small proportion of participants met the recommendations for fiber and saturated fat ( respectively 17 % and 30 % ) . Nonetheless , a high score was associated with lower values of plasma lipids , blood pressure , glycated hemoglobin , and BMI . The relationship of the single food items components of the rMED score with the achievement of treatment targets for plasma lipids , blood pressure , glucose , and BMI were also explored . The study findings support the Mediterranean dietary model as a suitable model for type 2 diabetes and the concept that the beneficial health effects of the Mediterranean diet lie primarily in its synergy among various nutrients and foods rather than on any individual component BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity . We have therefore systematic ally synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity . METHODS With the use of the Preferred Reporting Items for Systematic Review s and Meta-Analyses statement , prospect i ve studies were identified from search es in PubMed and PsycINFO from 2006 to 2016 . We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication .  Included articles were scored on their method ological quality , and a best- evidence synthesis was applied to summarize the results . RESULTS Our search result ed in 8,222 articles of which 67 articles were selected . In total , 124 determinants were identified of which 5 were demographic , 59 were behavioural , 51 were psychological/cognitive and 9 were social and physical environmental determinants . We found consistent evidence that demographic determinants were not predictive of weight loss maintenance . Behavioural and cognitive determinants that promote a reduction in energy intake , an increase in energy expenditure and monitoring of this balance are predictive determinants . CONCLUSION This review identifies key determinants in weight loss maintenance . However , more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance Approximately 80 % of patients with type 2 diabetes are overweight/obese ( 1 ) , and weight loss is the mainstay of treatment for these individuals . However , there is growing controversy as to whether reduced-fat or reduced-carbohydrate diets are best suited for this purpose , and results ( 2–8 ) in nondiabetic subjects suggest that lower carbohydrate diets are similarly or more efficacious in improving weight , triglycerides , and HDL cholesterol . There are no published r and omized studies evaluating the role of dietary macronutrients with respect to weight loss and cardiovascular risk improvement in patients with type 2 diabetes . Thus , we r and omized diet-treated patients with type 2 diabetes to hypocaloric diets , moderately restricted in either carbohydrate or fat , to determine whether weight loss or metabolic improvement differed as a function of macronutrient composition . A total of 29 patients with diet-treated type 2 diabetes were recruited from the San Francisco Bay area . All subjects gave written informed consent . Inclusion criteria included BMI 27–36 kg/m2 , fasting plasma glucose concentration 7.2–8.3 mmol/l , no use of antihyperglycemic medications , and stable weight for 3 months . Subjects on anti-hypertensive or cholesterol-lowering drugs or aspirin were allowed to continue their medications . Insulin-mediated glucose uptake was quantified by a modification ( 9 ) of the insulin suppression test as originally described ( 10 ) and vali date d ( 11 ) . In this test , a 180-min infusion of somatostatin ( 0.27 μg/m2 per min ) , insulin ( 25 mU/m2 per min ) , Adolescents with intellectual and developmental disabilities ( IDD ) are at an increased risk of obesity , with up to 55 % considered overweight and 31 % obese . However , there has been minimal research on weight management strategies for adolescents with IDD . The purpose of this study was to compare the effectiveness of two weight loss diets , an enhanced Stop Light Diet ( eSLD ) and a conventional diet ( CD ) , and to determine the feasibility of using tablet computers as a weight loss tool in overweight and obese adolescents with IDD . A 2-month pilot intervention was conducted . All participants were r and omized to the eSLD or CD  and were given a tablet computer that they used to track daily dietary intake and physical activity . Participants and parents met weekly with a registered dietitian nutritionist via video chat on the tablet computer to receive diet and physical activity feedback and education . Twenty participants ( 45 % female , aged 14.9±2.2 years ) were r and omized and completed the intervention . Participants in both diets were able to lose weight , and there were no significant differences between the eSLD and CD ( -3.89±2.66 kg vs -2.22±1.37 kg ) . Participants were able to use the tablet computer to track their dietary intake 83.4%±21.3 % of possible days and to attend 80.0 % of the video chat meetings . Both dietary interventions appear to promote weight loss in adolescents with IDD , and the use of tablet computers appears to be a feasible tool to deliver a weight loss intervention in adolescents with IDD AIMS Orlistat promotes weight loss in overweight and obese patients with Type 2 diabetes receiving hypoglycaemic treatment , but has not been investigated in patients with newly diagnosed and previously untreated Type 2 diabetes . We evaluated the efficacy of 24 weeks ' treatment with orlistat , combined with a mildly reduced-calorie diet , on weight loss and glycaemic control in overweight and obese patients with newly diagnosed and previously untreated Type 2 diabetes . METHODS A total of 249 Chinese patients ( body mass index 25 - 40 kg/m2 ) with recently diagnosed Type 2 diabetes were r and omized to placebo ( n=124 ) or orlistat 120 mg ( n=125 ) three times daily ; all patients followed a mildly reduced-calorie diet .  Patients had HbA1c 6.5 - 8.5 % ( mean 7.3 % ) and had never received any glucose-lowering medication . RESULTS Orlistat-treated patients achieved significantly greater weight loss at the study end than placebo-treated patients ( -5.4 vs. -2.4 kg ; P<0.0001 ) . More orlistat than placebo patients lost > or=5 % ( 60.5 vs. 26.8 % ; P<0.0001 ) and > or=10 % of their body weight ( 20.2 vs. 4.9 % ; P=0.0002 ) . A significantly greater decrease in HbA(1c ) from baseline was obtained with orlistat than placebo ( -1.0 vs. -0.6 % ; P=0.0008 ) . Orlistat-treated patients achieved a significantly greater decrease in fasting plasma glucose ( -1.3 vs. -0.5 mmol/l ; P=0.0003 ) and in the 2-h oral glucose tolerance test ( -4.1 vs. -1.4 mmol/l ; P<0.0001 ) than placebo recipients . Also , more orlistat- than placebo-treated patients improved from diabetic status to normal or impaired glucose tolerance ( 44.3 vs. 32.5 % ; P=0.0763 ) after 24 weeks . Orlistat also produced improvements in lipid profiles and waist circumference . CONCLUSIONS In combination with a mildly reduced-calorie diet , orlistat significantly reduces body weight , and improves glycaemic control and several cardiovascular risk factors in overweight and obese Chinese patients with newly diagnosed Type 2 diabetes Among 135 overweight subjects , we conducted a three-month r and omized controlled trial of two sets of dietary advice , each providing approximately 1,000 calories per day but differing in fiber , carbohydrate , and fat content . Information on weight and eating habits , as well as measures of lipoprotein and glucose metabolism were obtained at entry and one and three months later . We found that dieters given low carbohydrate/low fiber dietary advice tended to lose more weight than those given a higher carbohydrate/higher fiber regimen ( 5.0 vs 3.7 kg on average at three months ) . This pattern was particularly marked among women , and among participants who were under age 40 or of lower social class . There were no differences between the diet groups in the proportion complaining of hunger but , in general , members of the low carbohydrate group complained of more problems in dieting . There were only minor differences in the serum lipoprotein patterns during the diet period . In view of these results , we believe previous cl aims of the benefits of fiber for weight loss may have been overstated Introduction Healthy body weight is an important factor for prevention of breast cancerrecurrence . Yet , weight loss and weight gain are not currently included in clinical - practice guidelines for posttreatment of breast cancer . The work reportedaddresses one of the questions that must be considered in recommending weight lossto patients : does it matter what diet plan is used , a question of particular importance because breast cancer treatment can increase risk for cardiovasculardisease . Methods Women who completed treatment for breast cancer were enrolled in a nonr and omized , controlled study investigating effects of weight loss achieved by using twodietary patterns at the extremes of macronutrient composition , although both dietarms were equivalent in protein : high fat , low carbohydrate versus low fat , highcarbohydrate . A nonintervention group served as the control arm ; women wereassigned to intervention arms based on dietary preferences . During the 6-monthweight-loss program , which was menu and recipe defined , participants had monthly clinical visits at which anthropometric data were collected and fasting blood wasobtained for safety monitoring for plasma lipid profiles and fasting glucose . Results from 142 participants are reported . Results Adverse effects on fasting blood lipids or glucose were not observed in eitherdietary arm . A decrease in fasting glucose was observed with progressive weightloss and was greater in participants who lost more weight , but the effect was notstatistically significant , even though it was observed across both diet groups(P = 0.21 ) . Beneficial effects of weight loss on cholesterol ( 4.7%;P = 0.001 ) , triglycerides ( 21.8 % ; P = 0.01 ) , and low-densitylipoprotein ( LDL ) cholesterol ( 5.8 % ; P = 0.06 ) were observed in bothgroups . For cholesterol ( P = 0.07 ) and LDL cholesterol ( P = 0.13 ) , greater reduction trends were seen on the low-fat diet pattern ; whereas , for triglycerides ( P = 0.01 ) and high-density lipoprotein (HDL)cholesterol ( P = 0.08 ) , a decrease or increase , respectively , was greateron the low-carbohydrate diet pattern . Conclusions Because an individual 's dietary preferences can affect dietary adherence and weight-loss success , the lack of evidence of a negative effect of dietary patternon biomarkers associated with cardiovascular risk is an important consideration inthe development of breast cancer practice guidelines for physicians who recommendthat their patients lose weight . Whether dietary pattern affects biomarkers thatpredict long-term survival is a primary question in this ongoing clinical trial
None of the interventions were significantly better than the others in lowering glucose parameters .
The Mediterranean diet reduced HbA1c significantly compared to usual care but not compared to the Palaeolithic diet .
The effect of alterations in dietary practice irrespective of weight loss on glycaemic control can not be concluded from the present review .
BACKGROUND Overweight or obese individuals with type 2 diabetes are encouraged to lose weight for optimal glucose management , yet many find this difficult .
Determining whether alterations in dietary patterns irrespective of weight loss can aid glucose control has not been fully investigated .
METHODS We conducted a systematic review and meta- analysis aim ing to determine the effects of a Mediterranean diet compared to other dietary interventions on glycaemic control irrespective of weight loss .