Diets with high or low protein content and glycemic index for weight-loss maintenance
Open accessAbstract
BACKGROUND: Studies of weight-control diets that are high in protein or low in glycemic index have reached varied conclusions, probably owing to the fact that the studies had insufficient power. METHODS: We enrolled overweight adults from eight European countries who had lost at least 8% of their initial body weight with a 3.3-MJ (800-kcal) low-calorie diet. Participants were randomly assigned, in a two-by-two factorial design, to one of five ad libitum diets to prevent weight regain over a 26-week period: a low-protein and low-glycemic-index diet, a low-protein and high-glycemic-index diet, a high-protein and low-glycemic-index diet, a high-protein and high-glycemic-index diet, or a control diet. RESULTS: A total of 1209 adults were screened (mean age, 41 years; body-mass index [the weight in kilograms divided by the square of the height in meters], 34), of whom 938 entered the low-calorie-diet phase of the study. A total of 773 participants who completed that phase were randomly assigned to one of the five maintenance diets; 548 completed the intervention (71%). Fewer participants in the high-protein and the low-glycemic-index groups than in the low-protein-high-glycemic-index group dropped out of the study (26.4% and 25.6%, respectively, vs. 37.4%; P=0.02 and P=0.01 for the respective comparisons). The mean initial weight loss with the low-calorie diet was 11.0 kg. In the analysis of participants who completed the study, only the low-protein-high-glycemic-index diet was associated with subsequent significant weight regain (1.67 kg; 95% confidence interval [CI], 0.48 to 2.87). In an intention-to-treat analysis, the weight regain was 0.93 kg less (95% CI, 0.31 to 1.55) in the groups assigned to a high-protein diet than in those assigned to a low-protein diet (P=0.003) and 0.95 kg less (95% CI, 0.33 to 1.57) in the groups assigned to a low-glycemic-index diet than in those assigned to a high-glycemic-index diet (P=0.003). The analysis involving participants who completed the intervention produced similar results. The groups did not differ significantly with respect to diet-related adverse events. CONCLUSIONS: In this large European study, a modest increase in protein content and a modest reduction in the glycemic index led to an improvement in study completion and maintenance of weight loss. (Funded by the European Commission; ClinicalTrials.gov number, NCT00390637.).
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Compliance is known to increase when the foods are provided.
“However, compliance is known to increase when the foods are provided [34,48,56,64,66]”
From Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein (2021) · cites this paper as [64]
The Methods (Weight-Maintenance Phase; page unavailable) say that two centers provided free foods specifically to assess the effect of food provision on adherence. The passages from our copy do not report that providing foods increased adherence compared with instruction alone, so the claimed increase is not established by this paper. (LLM, conf=0.79)
Experimental — accuracy not yet measuredHigh-protein diets have received particular attention due to their potential to enhance satiety, preserve lean body mass, and attenuate adaptive reductions in resting energy expenditure that accompany weight loss.
“high-protein diets have received particular attention due to their potential to enhance satiety, preserve lean body mass, and attenuate adaptive reductions in resting energy expenditure that accompany weight loss”
From Weight maintenance after discontinuation of GLP-1 therapies (2026) · cites this paper as [59]
The introductory passage following the Abstract Conclusions says high protein content may have satiating effects and that interest in high-protein diets is increasing. The Discussion reports better weight-loss maintenance with high-protein diets, but no passage establishes preservation of lean body mass or attenuation of reductions in resting energy expenditure. The Discussion also reports no detected difference in self-perceived satiety. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHigher-protein diets may help maintain weight loss, especially when the overall diet has a low glycemic index.
“Diets with higher protein may also offer benefits for maintaining weight loss58, particularly when the overall diet has a low glycemic index59.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [59]
In the DIOGENES study, higher protein intake was associated with reduced weight regain but absolute differences between dietary groups were small (approximately 0.9 kg less regain over 26 weeks compared to lower protein intake, following an initial ~11 kg weight loss).
“higher protein intake was associated with reduced weight regain but absolute differences between dietary groups were small (approximately 0.9 kg less regain over 26 weeks compared to lower protein intake, following an initial ∼11 kg weight loss)”
From Weight maintenance after discontinuation of GLP-1 therapies (2026) · cites this paper as [59]
One large RCT of high-protein diet suggested benefit for weight loss maintenance, increasing satiety and energy expenditure, albeit for a maintenance phase of only 6 months after completing weight loss.
“One large RCT of high-protein diet suggested benefit for weight loss maintenance, increasing satiety and energy expenditure, albeit for a maintenance phase of only 6 months after completing weight loss [64].”
These neurophysiologic findings, together with longer feeding studies of weight-loss maintenance, suggest that reduced consumption of high-GI carbohydrates may ameliorate overeating and facilitate maintenance of a healthy weight in overweight and obese individuals.
“These neurophysiologic findings, together with longer feeding studies of weight-loss maintenance (48,49), suggest that a reduced consumption of high-GI carbohydrates (specifically, highly processed grain products, potatoes, and concentrated sugar) may ameliorate overeating and facilitate maintenance of a healthy weight in overweight and obese individuals.”
From Effects of dietary glycemic index on brain regions related to reward and craving in men (2013) · cites this paper as [48]
A high protein diet is not superior to other diets for weight loss, but recent evidence indicates it could be effective to prevent weight regain.
“Over the long term, even though the impact of a high protein diet on weight loss is not superior to other diets [71], recent evidence indicates that the use of a high protein diet could be an effective strategy to prevent weight regain [72,73].”
From Homeostatic and Circadian Control of Food Intake: Clinical Strategies to Prevent Overconsumption (2013) · cites this paper as [73]
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Self-citation
- Authors
- Larsen, T. M., Dalskov, S.-M., van Baak, M., Jebb, S. A., Papadaki, A., Pfeiffer, A. F. H., Martinez, J. A., Handjieva-Darlenska, T., Kunešová, M., Pihlsgård, M., Stender, S., Holst, C., Saris, W. H. M., & Astrup, A.
- Affiliations
- University of Copenhagen (DK)
- MRC Elsie Widdowson Laboratory (GB)
- University of Crete (GR)
- German Institute of Human Nutrition (DE)
- Institute of Endocrinology (CZ)
- Copenhagen University Hospital (DK)
- Maastricht University Medical Centre (NL)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-11-25
- Volume
- 363
- Issue
- 22
- Pages
- 2102-2113
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3359496
- OpenAlex
- W2167868973
- Cited by
- 843
- References
- 23
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 39 · 2023: 38 · 2022: 29 · 2021: 58 · 2020: 53 · 2019: 47 · 2018: 50 · 2017: 54 · 2016: 52 · 2015: 77 · 2014: 80 · 2013: 84 · 2012: 89
- FWCI
- 50.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Deposito Adademico Digital Universidad De Navarra (University of Navarra) (submittedVersion, other-oa)
- Bristol Research (University of Bristol) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- high-protein diet, low glycemic index diet, weight loss maintenance, weight regain prevention, hypocaloric diet, overweight adults, glycemic index, protein intake, dropout rates, weight loss sustainability, intention-to-treat analysis, body mass index
- MeSH terms
- Adult, Diet, Reducing, Dietary Proteins, Humans, Obesity, Patient Compliance, Biomarkers, Weight Loss, Abdominal Pain, Body Mass Index, Diet, Protein-Restricted, Glycemic Index, Overweight, Diet, Carbohydrate-Restricted, Intention to Treat Analysis
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