Page 493 - fbkCardioDiabetes_2017

Cardio Diabetes Medicine 2017 469

Studies showed VLED providing lesser calories did eg; Atkin’s, Dunkan, The Zone, South Beach, I-diet,
not provide greater weight loss and were less accept- Paleolithic diet, etc. Energy restriction is not there and
ed. VLED contains proteins, minerals, trace elements, they work by suppression of hunger and enhanced
and are vitamin enriched. they cause rapid weight satiety(12). Higher protein content with restricted car-
loss in 2-3 months should be used for weight loss bohydrates; no simple sugars, low GI carbohydrates,
induction and should be followed by weight main- high fiber and/or whole grain content. common
tenance program(8). Similar attrition for VLED and definition for low carbohydrate diet is ≤ 45% carbohy-
Low-energy diets (LED). Increased risk of gall stones drates, low fat diets have ≤ 30% fats and high protein
and concern about cardiac safety is there(12) diet have > 20% protein (but it can vary from 20-50%)
(12).
Low-energy diets (LED):
Many RCTs have been done comparing HPCLDs
It provides 800-1500 Kcal/day and usually made with low fat diets and it has been found that HP-
of natural foods - low fat, protein rich. Earlier diets CLDs score in weight loss, body composition, resting
had restricted total energy level but no importance metabolic rate and cardiovascular risk factors than
for macronutrient composition; they were known as low fat diets . Meta analysis of 23 RCTs by Santos
Conventional diets/Calorie-counting diets. For short et al involving 1141 obese non diabetics showed that
term weight reduction macronutrient composition is HPCLDs produced greater weight loss 7 kg over 6-12
not important but it has positive effects on cardiovas- months and difference maintained for 2 years. great-
cular risk factors, Insulin resistance, prevent cancers er reduction in waist circumference, systolic BP, dia-
and also supports long term weight maintenance. stolic BP, plasma triglycerides, fasting blood glucose,
LED for women is 800-1200 Kcal/day and for men glycated hemoglobin, plasma insulin, plasma hs-CRP
it is 1000-1500 Kcal/day. LED should be supplement- and in HDL cholesterol. No change in LDL-cholester-
ed with daily vitamins and minerals. Weight loss rate ol and serum creatinine(9).
is lower than VLED but t randomized control trials
(RCTs) show that the long term (>1year) weight loss In a meta-regression analysis of RCTs of 87 studies
is no different from VLED(9). 34 RCTs confirmed that with 165 groups done by Kreiger et al. to determine
LED causes weight loss regardless of the duration of the effects of changes in dietary protein and carbo-
treatment(12). hydrate contents during energy restriction conclud-
ed that HPCLDS positively influence body mass and
Ad libitum lower fat diets: composition independent of energy intake(10).
In the past dietary strategies were energy restricted Safety:
but the current strategy is to be ad libitum. Ad libitum
diet has a variety of macronutrients options which In healthier high fat diets, replacement of saturated
decreases the feeling of being restricted to a diet and transfats with unsaturated oils instead of carbo-
and so adherence and weight loss are improved(8). hydrates have shown positive benefits on cardiovas-
Studies have shown that high dietary fat leads to cular and diabetes profile; but there is risk of weight
development of obesity. Passive over consumption gain due to higher energy density food. DASH diet
of high energy dense fatty foods and a decreased with reduced fat or non fat dairy, fruits and vegeta-
fat oxidation capacity is the mechanism involved. bles, whole grains and lean meat has shown reduc-
Usually obese individuals consume high fat diet (35- tion in blood pressure (BP) and cardiovascular risk
50% of energy) so a lower fat diet (25-30% of energy) factors(12).
helps them along with increased protein, low-glyce- High protein intake can lead to decreased intake of
mic index (GI) carbohydrates, high fiber foods and fiber, vitamins and minerals (i.e. potassium, calcium,
whole grain; this ensures lowest cardiovascular risk magnesium) which can have negative influence on
profiles(12). Ad libitum programs have demonstrat- cardiovascular, bone and kidney functions(9). Stud-
ed weight loss and weight maintenance(8). A meta ies have shown that there is positive influence on
-analysis of 34 ad libitum diet, lasting > 2 months inflammation, risk factors for T2DM, bone health
and 35 groups found statistically significant weight and renal function(12). Again high protein diet have
loss difference of 3.3kg(12). not been found to be detrimental for kidneys as all
risk factors like diabetes, hypertension and obesity
Low-carbohydrate, high protein diets for impaired kidney function improve. Bone health is
(HPLCDs): maintained as they get the required protein, calcium
These are diets that are similar to ad libitum diets, and vitamin D(12).

Cardio Diabetes Medicine