Very low-energy, meal replacement diets most effective for diabetes remission, weight loss – Healio



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Churuangsuk reports receiving support with a PhD scholarship from the Prince of Songkla University, Thailand. Please see the study for all other authors’ relevant financial disclosures.

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Weight-loss programs that include very low-energy diets and formula meal replacements are the most effective for weight loss in type 2 diabetes, according to a systematic review published in Diabetologia.

Mike Lean

In a review of 19 meta-analyses, researchers also found that programs with a total diet replacement induction phase were the most effective dietary approach for type 2 diabetes remission, with up to 61% of participants achieving normoglycemia at 1 year.

Churuangsuk is a doctoral student in the department of human nutrition at the University of Glasgow.

“All people with type 2 diabetes should be offered a well-designed, professionally supported, structured diet program that is evidence-based, with the aim of achieving and sustaining at least 10 kg weight loss,” Mike Lean MA, MB BChir, MD, FRCP, FRSE, professor of human nutrition and consultant physician at the University of Glasgow and an adjunct professor at the University of Otago, told Healio. “That is possible with many diets, and no specific diet type has proved better than others. The best results are with a two-phased program, using a low-calorie (600-900 kcal/day) induction phase with a nutritionally balanced formula diet, unless individuals prefer a food-based approach. This can be delivered successfully in primary care, with attention to medication dose adjustments for glucose-lowering and antihypertensive drugs.”

Churuangsuk and colleagues identified 21 systematic reviews with 19 meta-analyses of randomized controlled trials of weight-loss diets conducted through May 2021. Researchers synthesized weight-loss findings, stratified by diet types, and assessed meta-analyses quality and the certainty of pooled results of each meta-analysis using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Of the 19 meta-analyses, 18 reported direct comparisons of specific diets. Most meta-analyses were of critically low (n = 7) to low quality (n = 5); only seven meta-analyses were assessed as high quality.

“Planned analysis of associations between changes in energy intake and weight changes from baseline, to differentiate effects of energy restriction and dietary regimen, proved impossible from the published information,” the researchers wrote.

Researchers found the greatest weight loss was reported with very low-energy diets of 400 kcal to 500 kcal per day for 8 to 12 weeks, achieving 6.6 kg greater weight loss than low-energy diets of 1,000 kcal to 1,500 kcal per day (95% CI, –9.5 to –3.7). One high-quality meta-analysis of nine randomized controlled trials reported that replacing one to three main meals daily (13% to 47% total energy) achieved 2.4 kg greater weight loss over 12 to 52 weeks (95% CI –3.3 to –1.4) compared with low-energy diets, according to researchers.

Low-carbohydrate diets were no better …….