Effect of Dietary Protein and Energy Restriction in the Improvement of Insulin Resistance in Subjects With Obesity

NCT03627104 | Completed DMC

• 1 other identifier: 2373
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

The prevention of obesity and its main medical complications, such as hypertension, type 2 diabetes and cardiovascular diseases, have been become a health priority. One of the most frequent metabolic complications in obesity is the insulin resistance and is the most important risk factor for the development of coronary diseases. The weight loss induced by the restriction of dietary energy is the cornerstone of therapy for people with obesity, as it improves or even regularizes insulin sensitivity and related comorbidities. However, weight loss induced by diet also decreases lean tissue mass, which could result in adverse effects on physical function. Although, regularly recommended to increase protein intake during weight loss, there is evidence to suggest that high protein intake could have deleterious metabolic effects. On the other hand, there is an association between the type of protein consumption, mainly the concentration of branched-chain amino acids (BCAAs) and insulin resistance during the dietary energy restriction in the therapy of obesity. There are multiple factors that influence the concentration of BCAAs and insulin resistance, which can be by phenotypic or genetic modification. The phenotypic modification refers to race, sex and dietary pattern. Meanwhile, the genetic modification refers to the activity of the enzymes responsible for the catabolism of BCAAs and genetic variants, such as the polymorphisms of a single nucleotide of said enzymes. A randomized controlled trial will be conducted with 160 participants (80 women and 80 men) divided by a draw in 4 groups, each for 20 participants. A feeding plan will be assigned according to the distribution of proteins (standard or high) and type of protein (animal or vegetable). The main aim of this study is to evaluate the effect on the amount and type of dietary protein and energy restriction on insulin resistance in subjects with obesity in a period of 1 month, considering the main factors that influence the concentration of BCAAs. In this way, evidence will be provided on what type of dietary intervention is most convenient for weight loss in subjects with insulin resistance and obesity.

Conditions

Obesity; Insulin Resistance

Outcome Measures

Primary Outcomes (1)

• Resistance insulin

  Change in the index HOMA-IR. The HOMA IR index will be calculated by the following equation: glucose (mg / dl) x insulin (mUI / ml) / 405 before and after of dietary intervention

  Baseline to 1-month

Secondary Outcomes (18)

• Amino acid profile

  Baseline to 1-month

• Change in body composition

  Baseline to 1-month

• Change in body weight

  Baseline to 1-month

• Change in waist circumference

  Baseline to 1-month

• Change in grip strength

  Baseline to 1-month

Study Arms (4)

Normoprotein diet with animal protein

OTHER

The patient will intake the diet assigned for a month

Dietary Supplement: Normoprotein diet with animal protein

Normoprotein diet with vegetable protein

OTHER

The patient will intake the diet assigned for a month

Dietary Supplement: Normoprotein diet with vegetable protein

High-protein diet with animal protein

OTHER

The patient will intake the diet assigned for a month

Dietary Supplement: High-protein diet with animal protein

High-protein diet with vegetable protein

OTHER

The patient will intake the diet assigned for a month

Dietary Supplement: High-protein diet with vegetable protein

Interventions

Normoprotein diet with animal protein DIETARY_SUPPLEMENT

Each patient will be attended for 1 month through 4 weekly visits. Weekly menus will be delivered according to diet with percentage of standard protein (12-18%) with a predominance of animal protein (60%). Regardless of the type of protein, menus will contain the same amount of energy and concentration of carbohydrates, fats and saturated fats (less than 7%).

Normoprotein diet with animal protein

Normoprotein diet with vegetable protein DIETARY_SUPPLEMENT

Each patient will be attended for 1 month through 4 weekly visits. Weekly menus will be delivered according to diet with percentage of standard protein (12-18%) with a predominance of vegetable protein (60%). Regardless of the type of protein, menus will contain the same amount of energy and concentration of carbohydrates, fats and saturated fats (less than 7%).

Normoprotein diet with vegetable protein

High-protein diet with animal protein DIETARY_SUPPLEMENT

Each patient will be attended for 1 month through 4 weekly visits. Weekly menus will be delivered according to diet with high-protein percentage (25-35%) with a predominance of animal protein (60%). Regardless of the type of protein, menus will contain the same amount of energy and concentration of carbohydrates, fats and saturated fats (less than 7%).

High-protein diet with animal protein

High-protein diet with vegetable protein DIETARY_SUPPLEMENT

ach patient will be attended for 1 month through 4 weekly visits. Weekly menus will be delivered according to diet with high-protein percentage (25-35%) with a predominance of vegetable protein (60%). Regardless of the type of protein, menus will contain the same amount of energy and concentration of carbohydrates, fats and saturated fats (less than 7%).

High-protein diet with vegetable protein

Eligibility Criteria

• Age: 20 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Adults (men and women) between the ages of 18 and 60.
• Patients with obesity (BMI ≥ 30 and ≤ 50 kg / m2) and with insulin resistance (HOMA - IR Index ≥ 2.5).
• Mexican mestizos (parents and grandparents born in Mexico).
• Patients who can read and write.

You may not qualify if:

• Patients with any type of diabetes.
• Patients with kidney disease diagnosed by a medical or with creatinine\> 1.3 mg / dL for men and \> 1.1 mg / dL for women and / or BUN\> 20 mg / dL.
• Patients with acquired diseases that produce obesity and diabetes secondarily.
• Patients who have suffered a cardiovascular event.
• Patients with weight loss \> 3 kg in the last 3 months.
• Patients with any catabolic diseases.
• Gravidity status
• Positive smoking
• Treatment with any medication

Sponsors & Collaborators

• Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran: lead

Study Sites (1)

Martha Guevara Cruz

Mexico City, 14060, Mexico

Location

Related Publications (21)

• Kirk EP, Klein S. Pathogenesis and pathophysiology of the cardiometabolic syndrome. J Clin Hypertens (Greenwich). 2009 Dec;11(12):761-5. doi: 10.1111/j.1559-4572.2009.00054.x.

  PMID: 20021538 BACKGROUND

• Klein S. Outcome success in obesity. Obes Res. 2001 Nov;9 Suppl 4:354S-358S. doi: 10.1038/oby.2001.142.

  PMID: 11707565 BACKGROUND

• Wycherley TP, Moran LJ, Clifton PM, Noakes M, Brinkworth GD. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2012 Dec;96(6):1281-98. doi: 10.3945/ajcn.112.044321. Epub 2012 Oct 24.

  PMID: 23097268 BACKGROUND

• Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND, Woods SC, Mattes RD. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015 Jun;101(6):1320S-1329S. doi: 10.3945/ajcn.114.084038. Epub 2015 Apr 29.

  PMID: 25926512 BACKGROUND

• Samson MM, Meeuwsen IB, Crowe A, Dessens JA, Duursma SA, Verhaar HJ. Relationships between physical performance measures, age, height and body weight in healthy adults. Age Ageing. 2000 May;29(3):235-42. doi: 10.1093/ageing/29.3.235.

  PMID: 10855906 BACKGROUND

• Phillips SK, Rook KM, Siddle NC, Bruce SA, Woledge RC. Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy. Clin Sci (Lond). 1993 Jan;84(1):95-8. doi: 10.1042/cs0840095.

  PMID: 8382141 BACKGROUND

• Brehm BJ, D'Alessio DA. Benefits of high-protein weight loss diets: enough evidence for practice? Curr Opin Endocrinol Diabetes Obes. 2008 Oct;15(5):416-21. doi: 10.1097/MED.0b013e328308dc13.

  PMID: 18769212 BACKGROUND

• Smith GI, Yoshino J, Stromsdorfer KL, Klein SJ, Magkos F, Reeds DN, Klein S, Mittendorfer B. Protein Ingestion Induces Muscle Insulin Resistance Independent of Leucine-Mediated mTOR Activation. Diabetes. 2015 May;64(5):1555-63. doi: 10.2337/db14-1279. Epub 2014 Dec 4.

  PMID: 25475435 BACKGROUND

• Krebs M, Krssak M, Bernroider E, Anderwald C, Brehm A, Meyerspeer M, Nowotny P, Roth E, Waldhausl W, Roden M. Mechanism of amino acid-induced skeletal muscle insulin resistance in humans. Diabetes. 2002 Mar;51(3):599-605. doi: 10.2337/diabetes.51.3.599.

  PMID: 11872656 BACKGROUND

• Robinson MM, Soop M, Sohn TS, Morse DM, Schimke JM, Klaus KA, Nair KS. High insulin combined with essential amino acids stimulates skeletal muscle mitochondrial protein synthesis while decreasing insulin sensitivity in healthy humans. J Clin Endocrinol Metab. 2014 Dec;99(12):E2574-83. doi: 10.1210/jc.2014-2736.

  PMID: 25222757 BACKGROUND

• Linn T, Geyer R, Prassek S, Laube H. Effect of dietary protein intake on insulin secretion and glucose metabolism in insulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1996 Nov;81(11):3938-43. doi: 10.1210/jcem.81.11.8923841.

  PMID: 8923841 BACKGROUND

• Sluijs I, Beulens JW, van der A DL, Spijkerman AM, Grobbee DE, van der Schouw YT. Dietary intake of total, animal, and vegetable protein and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL study. Diabetes Care. 2010 Jan;33(1):43-8. doi: 10.2337/dc09-1321. Epub 2009 Oct 13.

  PMID: 19825820 BACKGROUND

• Tinker LF, Sarto GE, Howard BV, Huang Y, Neuhouser ML, Mossavar-Rahmani Y, Beasley JM, Margolis KL, Eaton CB, Phillips LS, Prentice RL. Biomarker-calibrated dietary energy and protein intake associations with diabetes risk among postmenopausal women from the Women's Health Initiative. Am J Clin Nutr. 2011 Dec;94(6):1600-6. doi: 10.3945/ajcn.111.018648. Epub 2011 Nov 9.

  PMID: 22071707 BACKGROUND

• Rietman A, Schwarz J, Tome D, Kok FJ, Mensink M. High dietary protein intake, reducing or eliciting insulin resistance? Eur J Clin Nutr. 2014 Sep;68(9):973-9. doi: 10.1038/ejcn.2014.123. Epub 2014 Jul 2.

  PMID: 24986822 BACKGROUND

• Schwingshackl L, Hoffmann G. Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis. Nutr J. 2013 Apr 15;12:48. doi: 10.1186/1475-2891-12-48.

  PMID: 23587198 BACKGROUND

• Schooneman MG, Vaz FM, Houten SM, Soeters MR. Acylcarnitines: reflecting or inflicting insulin resistance? Diabetes. 2013 Jan;62(1):1-8. doi: 10.2337/db12-0466. No abstract available.

  PMID: 23258903 BACKGROUND

• Hattersley JG, Pfeiffer AF, Roden M, Petzke KJ, Hoffmann D, Rudovich NN, Randeva HS, Vatish M, Osterhoff M, Goegebakan O, Hornemann S, Nowotny P, Machann J, Hierholzer J, von Loeffelholz C, Mohlig M, Arafat AM, Weickert MO. Modulation of amino acid metabolic signatures by supplemented isoenergetic diets differing in protein and cereal fiber content. J Clin Endocrinol Metab. 2014 Dec;99(12):E2599-609. doi: 10.1210/jc.2014-2302.

  PMID: 25157543 BACKGROUND

• Lynch CJ, Adams SH. Branched-chain amino acids in metabolic signalling and insulin resistance. Nat Rev Endocrinol. 2014 Dec;10(12):723-36. doi: 10.1038/nrendo.2014.171. Epub 2014 Oct 7.

  PMID: 25287287 BACKGROUND

• Serralde-Zuniga AE, Guevara-Cruz M, Tovar AR, Herrera-Hernandez MF, Noriega LG, Granados O, Torres N. Omental adipose tissue gene expression, gene variants, branched-chain amino acids, and their relationship with metabolic syndrome and insulin resistance in humans. Genes Nutr. 2014 Nov;9(6):431. doi: 10.1007/s12263-014-0431-5. Epub 2014 Sep 27.

  PMID: 25260659 BACKGROUND

• Gonzalez-Salazar LE, Flores-Lopez A, Serralde-Zuniga AE, Avila-Nava A, Medina-Vera I, Hernandez-Gomez KG, Guizar-Heredia R, Ontiveros EP, Infante-Sierra H, Palacios-Gonzalez B, Velazquez-Villegas LA, Ortiz-Guiterrez S, Vazquez-Manjarrez N, Aguirre-Tostado PI, Vigil-Martinez A, Torres N, Tovar AR, Guevara-Cruz M. Effect of dietary protein on serum hepcidin and iron in adults with obesity and insulin resistance: A randomized single blind clinical trial. Nutr Metab Cardiovasc Dis. 2025 May;35(5):103785. doi: 10.1016/j.numecd.2024.10.023. Epub 2024 Nov 7.

  PMID: 39674725 DERIVED

• Gonzalez-Salazar LE, Pichardo-Ontiveros E, Palacios-Gonzalez B, Vigil-Martinez A, Granados-Portillo O, Guizar-Heredia R, Flores-Lopez A, Medina-Vera I, Heredia-G-Canton PK, Hernandez-Gomez KG, Castelan-Licona G, Arteaga-Sanchez L, Serralde-Zuniga AE, Avila-Nava A, Noriega-Lopez LG, Reyes-Garcia JG, Zerrweck C, Torres N, Tovar AR, Guevara-Cruz M. Effect of the intake of dietary protein on insulin resistance in subjects with obesity: a randomized controlled clinical trial. Eur J Nutr. 2021 Aug;60(5):2435-2447. doi: 10.1007/s00394-020-02428-5. Epub 2020 Nov 3.

  PMID: 33145643 DERIVED

MeSH Terms

Conditions

Obesity; Insulin Resistance

Interventions

Plant Proteins, Dietary; Diet, High-Protein

Condition Hierarchy (Ancestors)

Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Hyperinsulinism; Glucose Metabolism Disorders; Metabolic Diseases

Intervention Hierarchy (Ancestors)

Dietary Proteins; Proteins; Amino Acids, Peptides, and Proteins; Plant Proteins; Food; Diet, Food, and Nutrition; Physiological Phenomena; Food and Beverages; Diet Therapy; Nutrition Therapy; Therapeutics; Diet; Nutritional Physiological Phenomena

Study Officials

• Martha Guevara-Cruz, Dr

  Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: the person who will perform the statistical analysis will be blinded from the intervention group by assigning each patient
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD and PhD.

Model Details: The groups will receive the treatment simultaneously

Study Record Dates

• First Submitted: August 8, 2018
• First Posted: August 13, 2018
• Study Start: September 3, 2018
• Primary Completion: January 1, 2020
• Study Completion: January 1, 2020
• Last Updated: January 29, 2020

Record last verified: 2018-09

Data Sharing

• IPD Sharing: Will not share

Locations

ME (1)