Korean Diabetes J.  2009 Dec;33(6):526-536. 10.4093/kdj.2009.33.6.526.

The Effects of Low-Calorie Diets on Abdominal Visceral Fat, Muscle Mass, and Dietary Quality in Obese Type 2 Diabetic Subjects

• Ahn HJ
• Cho YO
• Kwon HR
• Ku YH
• Koo BK
• Han KA
• Min KW

• KMID: 2298059
• DOI: http://doi.org/10.4093/kdj.2009.33.6.526

Abstract

BACKGROUND
Weight loss through low-calorie diets (LCDs) decreases visceral fat (VF). However, the effects on muscle mass, changes of dietary quality, and insulin sensitivity are unknown for Korean obese type 2 diabetic subjects. Therefore, this study examined such effects of LCDs. METHODS: A total of 30 obese type 2 diabetic subjects (body mass index, 27.0 +/- 2.2 kg/m2) were randomly assigned to an LCD or control group. Subjects on LCDs took 500~1,000 kcal fewer energy than their usual dietary intake (1,000~1,500 kcal/day) over the course of 12 weeks. The abdominal VF and femoral muscle mass were evaluated by computed tomography, and insulin sensitivity was assessed using an insulin tolerance test (Kitt; rate constant for plasma glucose disappearance, %/min). Dietary nutrient intake consumed by subjects was assessed by 3-day food records. RESULTS: The percent VF reduction was -23.4 +/- 17.2% in the LCD group and -9.8 +/- 11.8% in the control group after 12 weeks (P < 0.001, P = 0.002). However, significant decrease in femoral mass or proportional change of marcronutrient intake and mean adequacy ratio were not found in the LCD group, as compared to the control group. Insulin sensitivity improved in the LCD group, as compared to the control group (P = 0.040). CONCLUSION: LCD effectively improved insulin sensitivity and reduced abdominal VF without reduction of femoral muscle and dietary quality in obese type 2 diabetic subjects.

Keyword

Caloric restriction; Intraabdominal fat; Type 2 diabetes mellitus; Weight loss

MeSH Terms

Caloric Restriction
Diabetes Mellitus, Type 2
Glucose
Insulin
Insulin Resistance
Intra-Abdominal Fat
Muscles
Plasma
Weight Loss
Glucose
Insulin

Reference

1. Baker S, Jerums G, Proietto J. Effects and clinical potential of very-low-calorie diets (VLCDs) in type 2 diabetes. Diabetes Res Clin Pract. 2009. 85:235–242.

2. Albu JB, Kovera AJ, Johnson JA. Fat distribution and health in obesity. Ann N Y Acad Sci. 2000. 904:491–501.

3. Despres JP, Pouliot MC, Moorjani S, Nadeau A, Tremblay A, Lupien PJ, Theriault G, Bouchard C. Loss of abdominal fat and metabolic response to exercise training in obese women. Am J Physiol. 1991. 261:E159–E167.

4. Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Kotani K, Tokunaga K. Pathophysiology and pathogenesis of visceral fat obesity. Obes Res. 1995. 3:suppl 2. S187–S194.

5. Song YD, Lim SK, Kim KR, Lee HC, Huh KB, Nam SY, Kim KW, Huh AJ, Choi BK, Chung DH. The effect of body fat distribution on glucose, lipid metabolism and growth hormone secretion in obesity. J Korean Soc Endocrinol. 1999. 14:541–552.

6. Hainer V, Toplak H, Mitrakou A. Treatment modalities of obesity: what fits whom? Diabetes Care. 2008. 31:suppl 2. S269–S277.

7. Klein S, Wadden T, Sugerman HJ. AGA technical review on obesity. Gastroenterology. 2002. 123:882–932.

8. Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care. 2004. 27:2067–2073.

9. Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, Holzmeister LA, Hoogwerf B, Mayer-Davis E, Mooradian AD, Purnell JQ, Wheeler M. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002. 25:148–198.

10. Delbridge E, Proietto J. State of the science: VLED (very low energy diet) for obesity. Asia Pac J Clin Nutr. 2006. 15:suppl. 49–54.

11. Son SM, Kim HJ. Effect of 12-week low calorie diet and behavior modification on the anthropometric indices and biochemical nutritional status of obese woman. Korean J Community Nutr. 2005. 10:525–535.

12. Choi MS. Effect of nutrition education and exercise intervention on health and diet quality of middle-aged women. Korean J Nutr. 2009. 42:48–58.

13. Park YK, Lee JH, Yoon JY, Park EJ, Chung YS, Lee HC, Hub KB. Effects of weight loss on glucose and lipid metabolism in overweight or obese NIDDM patients. J Korean Diabetes Assoc. 1994. 18:31–39.

14. Cho Y, Lee M, Jang H, Rha M, Kim J, Park Y, Sohn C. The clinical and cost effectiveness of medical nutrition therapy for patients with type 2 diabetes mellitus. Korean J Nutr. 2008. 41:147–155.

15. Park SW, Yun YS, Ahn CW, Nam JH, Kwon SH, Song MK, Han SH, Cha BS, Song YD, Lee HC, Hub KB. Short insulin tolerance test(SITT) for the determination of in vivo insulin sensitivity: a comparison with euglycemic clamp test. J Korean Diabetes Assoc. 1998. 22:199–208.

16. The Korean Nutrition Society. Dietary reference intakes for Koreans. 2005. Seoul: The Korean Nutrition Society.

17. Staged diabetes management. 2007. 3rd ed. Seoul: Korean Diabetes Association;3–9.

18. Kim NH, Kim JM, Kim HS, Chang N. Effects of nutrition and exercise education on fat mass and blood lipid profile in postmenopausal obese women. Korean J Nutr. 2007. 40:162–171.

19. National institutes of health technology assessment conference statement. methods for voluntary weight loss and control, march 30-april 1, 1992. Nutr Rev. 1992. 50:340–345.

20. Giannopoulou I, Ploutz-Snyder LL, Carhart R, Weinstock RS, Fernhall B, Goulopoulou S, Kanaley JA. Exercise is required for visceral fat loss in postmenopausal women with type 2 diabetes. J Clin Endocrinol Metab. 2005. 90:1511–1518.

21. Gasteyger C, Larsen TM, Vercruysse F, Pedersen D, Toubro S, Astrup A. Visceral fat loss induced by a low-calorie diet: A direct comparison between women and men. Diabetes Obes Metab. 2009. 11:596–602.

22. Kim SH, Kang ES, Park SY, Lee SJ, Kim MJ, Yoo JS, Ahn CW, Cha BS, Lim SK, Lee HC. The effects of lifestyle modification on the metabolic parameters of type 2 diabetes. J Korean Diabetes Assoc. 2004. 28:1–11.

23. Rafamantanantsoa HH, Ebine N, Yoshioka M, Higuchi H, Yoshitake Y, Tanaka H, Saitoh S, Jones PJ. Validation of three alternative methods to measure total energy expenditure against the doubly labeled water method for older Japanese men. J Nutr Sci Vitaminol(Tokyo). 2002. 48:517–523.

24. Miyazaki Y, DeFronzo RA. Visceral fat dominant distribution in male type 2 diabetic patients is closely related to hepatic insulin resistance, irrespective of body type. Cardiovasc Diabetol. 2009. 8:44.

25. Kelley DE, Wing R, Buonocore C, Sturis J, Polonsky K, Fitzsimmons M. Relative effects of calorie restriction and weight loss in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1993. 77:1287–1293.

26. Schneider R, Golzman B, Turkot S, Kogan J, Oren S. Effect of weight loss on blood pressure, arterial compliance, and insulin resistance in normotensive obese subjects. Am J Med Sci. 2005. 330:157–160.

27. Petersen KF, Dufour S, Befroy D, Lehrke M, Hendler RE, Shulman GI. Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes. 2005. 54:603–608.

28. Assali AR, Ganor A, Beigel Y, Shafer Z, Hershcovici T, Fainaru M. Insulin resistance in obesity: Body-weight or energy balance? J Endocrinol. 2001. 171:293–298.

29. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obes Res. 1998. 6:suppl 2. S51–S209.

30. Kang JH, Kim SW, Park HS, Kim HS. Comparison of clinical usefulness of low-calorie-diet combined with exercise and low-calorie-diet alone. J Korean Acad Fam Med. 1998. 19:167–176.

31. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000. 21:697–738.

32. Goodpaster BH, Kelley DE, Wing RR, Meier A, Thaete FL. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes. 1999. 48:839–847.

33. Park HS, Lee KU. Postmenopausal women lose less visceral adipose tissue during a weight reduction program. Menopause. 2003. 10:222–227.

34. Arner P. Differences in lipolysis between human subcutaneous and omental adipose tissues. Ann Med. 1995. 27:435–438.

35. Ferrannini E, Barrett EJ, Bevilacqua S, DeFronzo RA. Effect of fatty acids on glucose production and utilization in man. J Clin Invest. 1983. 72:1737–1747.

36. Chaston TB, Dixon JB, O'Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007. 31:743–750.

37. Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, Janssen I. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men: a randomized, controlled trial. Ann Intern Med. 2000. 133:92–103.

38. Bopp MJ, Houston DK, Lenchik L, Easter L, Kritchevsky SB, Nicklas BJ. Lean mass loss is associated with low protein intake during dietary-induced weight loss in postmenopausal women. J Am Diet Assoc. 2008. 108:1216–1220.

39. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Am J Clin Nutr. 1998. 68:899–917.

40. Lee YA, Kim KN, Chang N. The effect of nutrition education on weight control and diet quality in middle-aged women. Korean J Nutr. 2008. 41:54–64.