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Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial

Abstract

Aims

Very low-carbohydrate (LC) diets are popular for type 2 diabetes (T2DM) management; however, long-term effects on psychological health remain largely unknown. This study reports the effects of a LC diet on mood and cognitive function after 2 years and explores the potential predictors of changes in psychological health.

Methods

115 adults (57% males; age: 58.5 ± 7.1 years) with obesity and T2DM were randomized to consume an energy reduced (~ 500 to 1000 kcal/day deficit), LC diet [14% energy as carbohydrate, 28% protein, 58% fat (< 10% saturated fat)] or an isocaloric high unrefined carbohydrate, low-fat diet [HC: 53% carbohydrate, 17% protein, 30% fat (< 10% saturated fat)] for 2 years. Both diets were combined with aerobic/resistance exercise (1 h, 3 days/week). Mood/well-being [Beck Depression Inventory (BDI), Spielberger State Anxiety Inventory (SAI), Profile of Mood States (POMS)], diabetes-related quality of life [Diabetes-39 (D-39)] and distress [Problem Areas in Diabetes (PAID) Questionnaire], and cognitive function were assessed during and post-intervention.

Results

61 (LC: 33, HC: 28) participants completed the study. Weight loss was 9.1% after 12 months and 6.7% after 2 years with no difference between diet groups. There were no differences between the groups for the changes in any psychological health outcome (smallest p ≥ 0.19 for all time x diet interactions). Overtime, improvements in BDI, POMS [Total Mood Disturbance (TMD); four subscales], PAID, and D-39 (three subscales) scores occurred (p ≤ 0.05, time). Stepwise regression analysis showed improvements in BDI, POMS (TMD; two subscales), D-39, SAI, and PAID scores were significantly (p < 0.05) correlated with reductions in body weight and glycated hemoglobin.

Conclusion

In adults with obesity and T2DM, energy-restricted LC and HC diets produced comparable long-term improvements on a comprehensive range of psychological health outcomes. The findings suggest both diets can be used as a diabetes management strategy as part of a holistic lifestyle modification program without concern of negative effects on mental well-being or cognition.

Trial registration

ACTRN12612000369820, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362168&isReview=true. Data described in the manuscript, code book, and analytic code will not be made available because approval has not been granted by participants.

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Acknowledgements

We thank the volunteers for their participation. We gratefully acknowledge the work of the Clinical Research Team at the Commonwealth Scientific and Industrial Research Organisation (CSIRO)—Food and Nutrition, Adelaide, South Australia: Ann McGuffin, Julia Weaver and Vanessa Courage for coordinating the trial; Pennie Taylor, Janna Lutze, Paul Foster, Gemma Williams, Hannah Gilbert and Fiona Barr for assisting in designing and implementing the dietary intervention; Lindy Lawson, Theresa Mckinnon for nursing expertise and administering the questionnaires; Vanessa Danthiier for developing the cognitive test battery; Heidi Long and Laura Edney for administering the cognitive tests; Julie Syrette for performing the data scoring and data management; Luke Johnston and Annie Hastwell (Fit for Success, SA), Kelly French, Jason Delfos, Kristi Lacey-Powell, Marilyn Woods, John Perrin, Simon Pane, Annette Beckette (SA Aquatic Centre & Leisure Centre), and Angie Mondello and Josh Gniadek (Boot Camp Plus, SA), for conducting the exercise sessions.

Funding

This study was supported by a National Health and Medical Research Council of Australia Project Grant (APP103415).

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Authors

Contributions

GDB had full access to all the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Data analysis and interpretation of data: All authors. Drafting of the manuscript: NK, IZ, GDB. Critical revision the manuscript for intellectual content: All authors. Read and approved the final manuscript: All authors. Obtained funding: GDB, NLM, CHT, MN, JDB. Study supervision: GDB, JT, NLM, CHT, MN, JDB.

Corresponding author

Correspondence to Grant D. Brinkworth.

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The author declares that there is no competing interest.

Role of the sponsors

The sponsor has no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript.

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Kakoschke, N., Zajac, I.T., Tay, J. et al. Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial. Eur J Nutr 60, 4251–4262 (2021). https://doi.org/10.1007/s00394-021-02587-z

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Keywords

  • Diabetes
  • Diet
  • Macronutrient composition
  • Weight loss
  • Psychological well-being