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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.
STUDY PROGRAM The study will consist of a previous examination and 4 visits during the follow-up period.
Previous visit: pre-admission (Duration approximately 40 minutes)
Visit one:
a) Nutritional assessment (Ambulatory Patient Unit)
7. A food guide will be given so that they have food exchange options. 8. You will be taught to fill the feed log. 9. Patients will be cited within a week.
Visit two:
Visit three:
Visit four:
a) Nutritional assessment
6. There will be a 24-hour reminder. 7. The physical activity questionnaire will be carried out (IPAQ long version). The patient will be advised not to change the level of habitual physical activity.
8. Full feed logs will be collected. 9. It will be scheduled within fifteen days for delivery of results. Actions that will be carried out at the end of the study to maintain the continuity of the treatment
All patients after the end of the study, will be cited at 15 days where:
1. You will be given the results
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Normoprotein diet with animal protein | Other | The patient will intake the diet assigned for a month |
|
| Normoprotein diet with vegetable protein | Other | The patient will intake the diet assigned for a month |
|
| High-protein diet with animal protein | Other | The patient will intake the diet assigned for a month |
|
| High-protein diet with vegetable protein | Other | The patient will intake the diet assigned for a month |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 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%). |
| Measure | Description | Time Frame |
|---|---|---|
| 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 |
| Measure | Description | Time Frame |
|---|---|---|
| Amino acid profile | Change in the concentration of the amino acid profile, mainly of branched chain amino acids | Baseline to 1-month |
| Change in body composition | Change in fat mass, lean mass and skeletal muscle mass percentage |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Martha Guevara-Cruz, Dr | Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Martha Guevara Cruz | Mexico City | 14060 | Mexico |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20021538 | Background | 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. | |
| 11707565 | Background | Klein S. Outcome success in obesity. Obes Res. 2001 Nov;9 Suppl 4:354S-358S. doi: 10.1038/oby.2001.142. |
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The groups will receive the treatment simultaneously
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the person who will perform the statistical analysis will be blinded from the intervention group by assigning each patient
|
| 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%). |
|
| 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 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%). |
|
| Baseline to 1-month |
| Change in body weight | change in body weight before and after of dietary intervention | Baseline to 1-month |
| Change in waist circumference | Change in waist circumference before and after of dietary intervention | Baseline to 1-month |
| Change in grip strength | Change in grip strength before and after the intervention by dynamometry | Baseline to 1-month |
| Change in respiratory quotient | The respiratory coefficient will be determined by indirect calorimetry | Baseline to 1-month |
| Change in glucose serum | The concentration of serum glucose will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in total cholesterol serum | The concentration of serum total cholesterol will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in HDL cholesterol serum | The concentration of serum HDL-cholesterol will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in triglycerides serum | The concentration of serum triglycerides will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in LDL cholesterol serum | The concentration of serum LDL cholesterol will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in free fatty acids serum | The concentration of free fatty acids will be determined before and after the intervention | Baseline to 1-month |
| Change liver function tests | The concentration of serum liver enzymes will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in concentration of leptin serum | The concentration of serum leptin will be determined by ELISA kit before and after the intervention | Baseline to 1-month |
| Change in concentration of adiponectin serum | The concentration of serum adiponectin will be determined by ELISA kit before and after the intervention | Baseline to 1-month |
| Change in the concentration of C-reactive protein | The concentration of serum C- reactive protein will be determined by autoanalyzer before and after the intervention | Baseline to 1-month |
| Change in systolic and diastolic blood pressure | the blod pressure will be determined before and after the intervention | Baseline to 1-month |
| Change of the HOMA index according to the presence or absence of polymorphism related to the metabolism of branched chain amino acids (rs11548193 and rs45500792). | HOMA (IR-HOMA) which is calculated glucose (mg / dl) x insulin (mUI / ml) / 405 before and after of dietary intervention | Baseline to 1- month |
| 23097268 | 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. |
| 25926512 | 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. |
| 10855906 | 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. |
| 8382141 | 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. |
| 18769212 | 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. |
| 25475435 | 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. |
| 11872656 | 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. |
| 25222757 | 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. |
| 8923841 | 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. |
| 19825820 | 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. |
| 22071707 | 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. |
| 24986822 | 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. |
| 23587198 | 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. |
| 23258903 | 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. |
| 25157543 | 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. |
| 25287287 | 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. |
| 25260659 | 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. |
| 39674725 | Derived | 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. |
| 33145643 | 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. |
| ID | Term |
|---|---|
| D009765 | Obesity |
| D007333 | Insulin Resistance |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006946 | Hyperinsulinism |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
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| ID | Term |
|---|---|
| D014674 | Plant Proteins, Dietary |
| D000073600 | Diet, High-Protein |
| ID | Term |
|---|---|
| D004044 | Dietary Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D010940 | Plant Proteins |
| D005502 | Food |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D019602 | Food and Beverages |
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
| D004032 | Diet |
| D009747 | Nutritional Physiological Phenomena |
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