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Cited by 98Diet and metabolism studiesDietary Effects on HealthDiet, Metabolism, and Disease

A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes

Open access
Gower, Barbara A, Goss, Amy M·2015·The Journal of Nutrition
DOI 10.3945/jn.114.195065PMC PMC4264021
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Abstract

Background Obesity, particularly visceral and ectopic adiposity, increases the risk of type 2 diabetes.Objective The aim of this study was to determine if restriction of dietary carbohydrate is beneficial for body composition and metabolic health.Methods Two studies were conducted. In the first, 69 overweight/obese men and women, 53% of whom were European American (EA) and 47% of whom were African American (AA), were provided with 1 of 2 diets (lower-fat diet: 55%, 18%, and 27% of energy from carbohydrate, protein, and fat, respectively; lower-carbohydrate diet: 43%, 18%, and 39%, respectively) for 8 wk at a eucaloric level and 8 wk at a hypocaloric level. In the second study, 30 women with polycystic ovary syndrome (PCOS) were provided with 2 diets (lower-fat diet: 55%, 18%, and 27% of energy from carbohydrate, protein, and fat, respectively; lower-carbohydrate diet: 41%, 19%, and 40%, respectively) at a eucaloric level for 8 wk in a random-order crossover design.Results As previously reported, among overweight/obese adults, after the eucaloric phase, participants who consumed the lower-carbohydrate vs. the lower-fat diet lost more intra-abdominal adipose tissue (IAAT) (11 ± 3% vs. 1 ± 3%; P < 0.05). After weight loss, participants who consumed the lower-carbohydrate diet had 4.4% less total fat mass. Original to this report, across the entire 16-wk study, AAs lost more fat mass with a lower-carbohydrate diet (6.2 vs. 2.9 kg; P < 0.01), whereas EAs showed no difference between diets. As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (-2.8 μIU/mL; P < 0.001) and fasting glucose (-4.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and "dynamic" β-cell response (96.1 · 10(9); P < 0.001). In the lower-carbohydrate arm, women lost both IAAT (-4.8 cm(2); P < 0.01) and intermuscular fat (-1.2 cm(2); P < 0.01). In the lower-fat arm, women lost lean mass (-0.6 kg; P < 0.05). Original to this report, after the lower-carbohydrate arm, the change in IAAT was positively associated with the change in tumor necrosis factor α (P < 0.05).Conclusion A modest reduction in dietary carbohydrate has beneficial effects on body composition, fat distribution, and glucose metabolism. This trial was registered at clinicaltrials.gov as NCT00726908 and NCT01028989.

AI snapshot

Written from the paper’s full text.

TL;DR

In two studies of adults at risk of type 2 diabetes, a modestly lower-carbohydrate, higher-fat diet improved body composition, fat distribution, and glucose metabolism compared with a lower-fat diet. The lower-carbohydrate diet reduced intra-abdominal and intermuscular fat and increased insulin sensitivity, with ethnic differences in fat loss.

Key findings

  • In overweight/obese adults during the eucaloric phase, the lower-carbohydrate vs. lower-fat diet produced greater loss of intra-abdominal adipose tissue (IAAT) (11 ± 3% vs. 1 ± 3%; P < 0.05); during the hypocaloric phase, the lower-carbohydrate group had 4.4% less total fat mass (P < 0.05).
  • Across the entire 16-wk study, African American participants lost more fat mass with the lower-carbohydrate diet (6.2 vs. 2.9 kg; P < 0.01), whereas European American participants showed no difference between diets.
  • In women with polycystic ovary syndrome (PCOS), the lower-carbohydrate arm decreased fasting insulin (P < 0.001) and fasting glucose (P < 0.01) and increased insulin sensitivity (P < 0.05) and dynamic β-cell response (P < 0.001); women lost IAAT (24.8 cm²; P < 0.01) and intermuscular fat (21.2 cm²; P < 0.01), while the lower-fat arm lost lean mass (P < 0.05).
  • Markers of inflammation did not change with either diet in either study; after the lower-carbohydrate arm in PCOS, change in IAAT was positively associated with change in TNF-α (standardized coefficient = 0.45, P = 0.04).

Methods

  • Study 1: 69 overweight/obese nondiabetic men and women aged 21–50 y, approximately 50% African American and 50% European American by design, were assigned to a lower-fat diet (55% carbohydrate, 18% protein, 27% fat) or lower-carbohydrate diet (43% carbohydrate, 18% protein, 39% fat) for 8 wk eucaloric followed by 8 wk hypocaloric (−1000 kcal/d); body composition by DXA, fat distribution by CT, and acute insulin response to glucose were assessed.
  • Study 2: 30 women with PCOS were enrolled in a random-order crossover design with lower-fat (55% carbohydrate, 18% protein, 27% fat) and lower-carbohydrate (41% carbohydrate, 19% protein, 40% fat) diets at a eucaloric level for 8 wk each, with a 4-wk washout; outcomes included fasting glucose, fasting insulin, insulin sensitivity, β-cell response, DXA, CT-measured IAAT and intermuscular adipose tissue, and circulating inflammation markers.
  • Analyses used paired t tests, ANCOVA, and multiple linear regression with SAS version 9.3 and α = 0.05; some outcomes were previously reported, and original analyses in this report addressed inflammation and ethnic-group responses.

Limitations

  • The paper states that the lower-carbohydrate prescription (43% carbohydrate) may not have been sufficiently low to reduce inflammation, and that the greater saturated fat content (12–13%) may have negated any beneficial effect of carbohydrate reduction.
  • The paper states that longer-term and prospective studies are needed to examine inflammation, phenotype-by-diet interactions, and effects in African American and European American adults.
  • Evident from the text: the studies had small samples and short 8-wk diet arms, many outcomes were previously reported, and no blinding is described; the lack of change in inflammation markers limits conclusions about anti-inflammatory effects.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3945/jn.114.195065

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 76 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Markers of inflammation did not change in response to either diet in women with polycystic ovary syndrome.

    “Original to this report, markers of inflammation did not change in response to either of the diets (Table 2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the lower-carbohydrate arm, women with polycystic ovary syndrome lost intermuscular fat.

    “In the lower-carbohydrate arm, women lost both IAAT (24.8 cm 2 ; P < 0.01) and intermuscular fat (21.2 cm 2 ; P < 0.01).”
    • Also stated in: § Results · plain
      “As previously reported (32), while in the lower-carbohydrate arm, women lost both IAAT (P < 0.01) and IMAT (P < 0.01).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Goss, 2014, Effects of a eucaloric reduced carbohydrate diet on body composition and fat distribution in women with PCOS, Metabolism source

      Not checked in the free run.

  • Findingcitation

    Among women with polycystic ovary syndrome, the lower-carbohydrate arm showed decreased fasting insulin.

    “As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (22.8 mIU/mL; P < 0.001) and fasting glucose (24.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and ''dynamic'' b-cell response (96.1 Á 10 9 ; P < 0.001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Gower, 2013, Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS, Clin Endocrinol (Oxf) source

      Not checked in the free run.

  • Findingown data

    Markers of inflammation did not change in response to either diet in overweight/obese adults.

    “Original to this report, markers of inflammation did not change in response to either of the diets (P > 0.05) when data were analyzed by paired t test or ANCOVA (Table 2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    No change in lean mass was observed over the course of the lower-carbohydrate arm in women with polycystic ovary syndrome.

    “No changes in IAAT or IMAT were observed during the lower-fat arm, and no change in lean mass was observed over the course of the lower-carbohydrate arm.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 16
  • Classified as probably not a substantial claim. 24

  • May combine two claims.

    Findingcitation

    No changes in fasting insulin, fasting glucose, insulin sensitivity, or dynamic beta-cell response were observed while consuming the lower-fat diet in women with polycystic ovary syndrome.

    “No changes in these outcomes were observed while consuming the lower-fat diet.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Gower, 2013, Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS, Clin Endocrinol (Oxf) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Loss of total fat mass was significant with both diets but greater with the lower-carbohydrate diet in women with polycystic ovary syndrome.

    “Although loss of total fat mass was significant with both diets, it was greater with the lower-carbohydrate diet (P < 0.05; adjusted for baseline total fat mass and change in lean mass).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    AUC glucose did not differ between the two breakfast meals.

    “AUC glucose did not differ between the 2 meals; however, serum glucose concentration was lower at 3 and 4 h during the lower-fat meal (P < 0.05).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Chandler-Laney, 2014, Return of hunger following a relatively high carbohydrate breakfast is associated with earlier recorded glucose peak and nadir, Appetite source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    African American participants had 40% greater acute insulin response to glucose than European American participants.

    “However, AAs had 40% greater AIRg (P < 0.01).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No changes in intra-abdominal adipose tissue or intermuscular adipose tissue were observed during the lower-fat arm in women with polycystic ovary syndrome.

    “No changes in IAAT or IMAT were observed during the lower-fat arm, and no change in lean mass was observed over the course of the lower-carbohydrate arm.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Serum glucose concentration was lower at 3 and 4 hours during the lower-fat meal than during the lower-carbohydrate meal.

    “AUC glucose did not differ between the 2 meals; however, serum glucose concentration was lower at 3 and 4 h during the lower-fat meal (P < 0.05).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Chandler-Laney, 2014, Return of hunger following a relatively high carbohydrate breakfast is associated with earlier recorded glucose peak and nadir, Appetite source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Obesity, particularly visceral and ectopic adiposity, increases the risk of type 2 diabetes.

    “Obesity, particularly visceral and ectopic adiposity, increases the risk of type 2 diabetes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Bays, 2004, Role of the adipocyte, free fatty acids, and ectopic fat in pathogenesis of type 2 diabetes mellitus: peroxisomal proliferator-activated receptor agonists provide a rational therapeutic approach, J Clin Endocrinol Metab source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A number of studies documented benefits of lower-carbohydrate diets for weight loss and improved metabolic health in healthy individuals.

    “A number of studies documented the benefits of lower-carbohydrate diets on measures of metabolic health and medication use in patients with T2D (6)(7)(8)(9)(10)(11) and for weight loss and improved metabolic health in healthy individuals (12).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Hu, 2014, The low-carbohydrate diet and cardiovascular risk factors: evidence from epidemiologic studies, Nutr Metab Cardiovasc Dis source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Elevated insulin secretion promotes glucose oxidation, impairs fat oxidation, facilitates de novo lipogenesis, and promotes storage of fat.

    “The consumption of processed carbohydrates leads to elevated insulin secretion, which, in turn, promotes glucose oxidation, impairs fat oxidation, facilitates de novo lipogenesis, and promotes storage of fat (2), while at the same time leading to insulin resistance, inflammation (3), and oxidative stress (4).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Magkos, 2010, Metabolic actions of insulin in men and women, Nutrition source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The combination of insulin resistance and hyperinsulinemia disrupts lipid metabolism and increases the risk of cardiovascular disease.

    “The combination of insulin resistance and hyperinsulinemia also disrupts lipid metabolism and increases the risk of cardiovascular disease, the most common source of mortality among individuals with T2D (5).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Morrish, 2001, Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumption of processed carbohydrates leads to insulin resistance, inflammation, and oxidative stress.

    “The consumption of processed carbohydrates leads to elevated insulin secretion, which, in turn, promotes glucose oxidation, impairs fat oxidation, facilitates de novo lipogenesis, and promotes storage of fat (2), while at the same time leading to insulin resistance, inflammation (3), and oxidative stress (4).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Buyken, 2014, Association between carbohydrate quality and inflammatory markers: systematic review of observational and interventional studies, Am J Clin Nutr source

      Not checked in the free run.

    • cites [4] de Carvalho Vidigal, 2012, The role of hyperglycemia in the induction of oxidative stress and inflammatory process, Nutr Hosp

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Insulin resistance, in combination with beta cell dysfunction, contributes to the development of type 2 diabetes.

    “Insulin resistance, in combination with b cell dysfunction, contributes to the development of type 2 diabetes (T2D) 4 (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Bays, 2004, Role of the adipocyte, free fatty acids, and ectopic fat in pathogenesis of type 2 diabetes mellitus: peroxisomal proliferator-activated receptor agonists provide a rational therapeutic approach, J Clin Endocrinol Metab source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    African American and European American participants did not differ with respect to age, BMI, or fat mass.

    “AA and EA participants did not differ with respect to age, BMI, or fat mass.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the polycystic ovary syndrome study, participants were assigned by using a randomization scheme to one of two diets.

    “After completing baseline testing, participants were assigned, by using a randomization scheme, to 1 of 2 diets: a lower-fat diet with a macronutrient composition of 55% carbohydrate, 18% protein, and 27% fat (% of energy from each) or a lower-carbohydrate diet with a macronutrient composition of 41% carbohydrate, 19% protein, and 40% fat.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Insulin sensitivity was selected as a covariate because it interacts with diet composition in determining changes in body composition over time.

    “Insulin sensitivity was selected as a covariate because it interacts with diet composition in determining changes in body composition over time (15,16).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Gower, 2010, Glucose metabolism and diet predict changes in adiposity and fat distribution in weight-reduced women, Obesity (Silver Spring) source

      Not checked in the free run.

    • cites [16] Gower, 2013, Insulin sensitivity affects propensity to obesity in an ethnic-specific manner: results from two controlled weight loss intervention studies, Nutr Metab (Lond) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women with polycystic ovary syndrome are characterized by insulin resistance, hyperinsulinism, and perhaps visceral adiposity.

    “Women with PCOS are characterized by insulin resistance, hyperinsulinism, and perhaps visceral adiposity (22)(23)(24) and are therefore at increased risk of T2D.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] Chang, 1983, Insulin resistance in nonobese patients with polycystic ovarian disease, J Clin Endocrinol Metab source

      Not checked in the free run.

    • cites [23] Dunaif, 1997, Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis, Endocr Rev

      Not checked in the free run.

    • cites [24] Borruel, 2013, Global adiposity and thickness of intraperitoneal and mesenteric adipose tissue depots are increased in women with polycystic ovary syndrome (PCOS), J Clin Endocrinol Metab source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    A modest reduction in dietary carbohydrate has beneficial effects on body composition, fat distribution, and glucose metabolism.

    “A modest reduction in dietary carbohydrate has beneficial effects on body composition, fat distribution, and glucose metabolism.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: When dietary carbohydrate is restricted and insulin declines, metabolic processes shift to favor fat oxidation over lipid storage.
    • Rests on an assumption: When dietary carbohydrate is restricted and insulin declines, the lipid profile improves and lipotoxic processes that impair beta cell function and insulin action resolve.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    In both studies, the two experimental diets were matched for protein content to avoid potential confounding effects of altered protein intake on body composition or metabolic outcomes.

    “In both studies, the 2 experimental diets were matched for protein content to avoid potential confounding effects of altered protein intake on body composition or metabolic outcomes.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Intra-abdominal adipose tissue is a depot associated with metabolic dysfunction that is enlarged in individuals with type 2 diabetes.

    “a depot associated with metabolic dysfunction that is enlarged in individuals with T2D (34,35).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Carey, 1997, Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ Health Study, Am J Epidemiol source

      Not checked in the free run.

    • cites [35] Chan, 1994, Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men, Diabetes Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Greater IMAT was observed in men with T2D and is associated with greater prevalence of hyperglycemia.

    “However, greater IMAT was observed in men with T2D and has been associated with greater prevalence of hyperglycemia (45).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Miljkovic-Gacic, 2008, Adipose tissue infiltration in skeletal muscle: age patterns and association with diabetes among men of African ancestry, Am J Clin Nutr source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Dietary protein affects insulin secretion.

    “In addition, dietary protein affects insulin secretion (53) and satiety (54).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Nuttall, 1991, Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Carbohydrate restriction reduces insulin secretion, which may facilitate fat mobilization, particularly from the intra-abdominal area.

    “These observations suggest that carbohydrate restriction reduces insulin secretion, which may facilitate fat mobilization (33), particularly from the intra-abdominal area, a depot associated with metabolic dysfunction that is enlarged in individuals with T2D (34,35).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Karpe, 2011, Fatty acids, obesity, and insulin resistance: time for a reevaluation, Diabetes source

      Not checked in the free run.

    • Rests on an assumption: When dietary carbohydrate is restricted and insulin declines, metabolic processes shift to favor fat oxidation over lipid storage.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    On a cross-sectional basis, tumor necrosis factor alpha was associated with intra-abdominal adipose tissue but not with total fat mass or any other individual fat depot.

    “Furthermore, on a cross-sectional basis, TNF-a was associated with IAAT but not with total fat mass or any other individual fat depot (37).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Hyatt, 2009, Insulin sensitivity in African-American and Caucasian women: association with inflammation, Obesity (Silver Spring) source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Among individuals at elevated risk of T2D (overweight/obese/prediabetic adults and women with PCOS), restriction of dietary carbohydrate relative to restriction of dietary fat resulted in favorable changes in body composition, fat distribution, and glucose metabolism that may reduce the risk of T2D.

    “In summary, among 2 groups of individuals at elevated risk of T2D (overweight/obese/prediabetic adults, women with PCOS), restriction of dietary carbohydrate (relative to restriction of dietary fat) resulted in favorable changes in body composition, fat distribution, and glucose metabolism that may reduce the risk of T2D.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    We previously observed that insulin-sensitive African American women who consumed a diet relatively high in glycemic load showed greater gain in body fat under freeliving conditions.

    “We previously observed that insulin-sensitive AA women who consumed a diet relatively high in glycemic load showed greater gain in body fat under freeliving conditions (16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Gower, 2013, Insulin sensitivity affects propensity to obesity in an ethnic-specific manner: results from two controlled weight loss intervention studies, Nutr Metab (Lond) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In a previous study involving weight loss with a hypocaloric prescription, decreases in all markers of inflammation assessed were observed, with the decrease in tumor necrosis factor alpha best explained by the decrease in intra-abdominal adipose tissue.

    “In a previous study that involved weight loss with the use of a hypocaloric prescription, we observed decreases in all markers of inflammation assessed, with the decrease in TNF-a best explained by the decrease in IAAT (36).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Fisher, 2011, Effect of diet with and without exercise training on markers of inflammation and fat distribution in overweight women, Obesity (Silver Spring) source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Fatty infiltration of skeletal muscle is either a contributor to, or a marker of, impaired metabolic health.

    “These observations suggest that fatty infiltration of skeletal muscle is either a contributor to, or a marker of, impaired metabolic health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    In the study, food was provided throughout, so differences in satiety/hunger were not anticipated to affect study results because food intake was determined by the study protocol.

    “We provided food throughout the study; thus, we did not anticipate that differences in satiety/hunger would affect study results, because food intake was determined by the study protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Elevated dietary protein may contribute to maintenance of, or gain in, lean body mass.

    “Elevated dietary protein may contribute to maintenance of, or gain in, lean body mass (52).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Mettler, 2010, Increased protein intake reduces lean body mass loss during weight loss in athletes, Med Sci Sports Exerc source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A low or inadequate first-phase beta cell response is one of the first signs of impaired beta cell function.

    “A low or inadequate first-phase b cell response is one of the first signs of impaired b cell function (39) and appears to occur due to glucose toxicity (40)(41)(42)(43).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Abdul-Ghani, 2008, The relationship between fasting hyperglycemia and insulin secretion in subjects with normal or impaired glucose tolerance, Am J Physiol Endocrinol Metab source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A low or inadequate first-phase beta cell response appears to occur due to glucose toxicity.

    “A low or inadequate first-phase b cell response is one of the first signs of impaired b cell function (39) and appears to occur due to glucose toxicity (40)(41)(42)(43).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [40] Godsland, 2004, Loss of beta cell function as fasting glucose increases in the non-diabetic range, Diabetologia source

      Not checked in the free run.

    • cites [41] Gastaldelli, 2004, Beta-cell dysfunction and glucose intolerance: results from the San Antonio metabolims (SAM) study, Diabetologia source

      Not checked in the free run.

    • cites [42] Meyer, 2002, Acute hyperglycemia alters the ability of the normal beta-cell to sense and respond to glucose, Am J Physiol Endocrinol Metab source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In women with or without PCOS, in vitro TNF-alpha production is correlated with circulating concentrations of testosterone and androstenedione.

    “In women with or without PCOS, in vitro TNF-a production was correlated with circulating concentrations of testosterone and androstenedione (51).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] González F, Kirwan JP, Rote NS, Minium J. Evidence of mononuclear cell preactivation in the fasting state in polycystic ovary syndrome. Am J Obstet Gynecol 2014 Jun 20 (Epub ahead of print; DOI: 10.1016/j.ajog.2014.06.044).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dietary protein affects satiety.

    “In addition, dietary protein affects insulin secretion (53) and satiety (54).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Paddon-Jones, 2008, Protein, weight management, and satiety, Am J Clin Nutr source

      Not checked in the free run.

33 of 33

  • The paper relies on this without support.

    When dietary carbohydrate is restricted and insulin declines, metabolic processes shift to favor fat oxidation over lipid storage.

    “In contrast, when dietary carbohydrate is restricted and insulin declines, metabolic processes shift to favor fat oxidation over lipid storage.”

  • The paper relies on this without support.

    When dietary carbohydrate is restricted and insulin declines, the lipid profile improves and lipotoxic processes that impair beta cell function and insulin action resolve.

    “As a result, the lipid profile improves, and lipotoxic processes that impair b cell function and insulin action resolve.”

  • The paper relies on this without support.

    African Americans, Mexican Americans, and Native Americans are at greater risk of both obesity and type 2 diabetes compared with European Americans.

    “All of these minority groups are at greater risk of both obesity and T2D compared with EAs.”

  • The paper relies on this without support.

    There is a need for nonpharmacologic treatment options for PCOS.

    “Although treatment with oral contraceptives and other drugs that alter the reproductiveendocrine axis can alleviate symptoms, there is a need for nonpharmacologic treatment options.”

  • The paper relies on this without support.

    The role of IMAT in the etiology of chronic metabolic disease has not been widely investigated.

    “The role of IMAT in the etiology of chronic metabolic disease has not been widely investigated.”
5 of 5

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Authors
Gower, B. A., & Goss, A. M.
Affiliations
University of Alabama at Birmingham (US)
Corresponding author
Gower, Barbara A
ORCID
Venue
The Journal of Nutrition
Publisher
Elsevier BV
Published
2015-01
Volume
145
Issue
1
Pages
177S-183S
ISSN
0022-3166 (ISSN-L)
DOI
10.3945/jn.114.195065
PMC
PMC4264021
OpenAlex
W2060603521
Semantic Scholar
b96a4c2139543414f5c8968e5e16ec5281988250
Cited by
98
References
58
Citations by year
2026: 6 · 2025: 11 · 2024: 10 · 2023: 3 · 2022: 10 · 2021: 6 · 2020: 9 · 2019: 7 · 2018: 5 · 2017: 11 · 2016: 14 · 2015: 6
FWCI
6.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Alabama at Birmingham (P30DK56336)
  • Egg Nutrition Center
  • University of Alabama
  • National Institutes of Health (5ul1rr025777-04, 5p60dk079626-05, UL1TR001417)
  • Center for Clinical and Translational Science, University of Alabama at Birmingham (UL1RR025777)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK67538, P60-DK-079626, R01DK067538, P30-DK56336, T32DK062710, P30DK056336, P30DK079626)
  • National Center for Research Resources (UL1-RR-025777)
  • National Center for Advancing Translational Sciences
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD054960)
Topics
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
dietary fat restriction, type 2 diabetes prevention, insulin sensitivity, intra-abdominal adipose tissue, visceral fat, polycystic ovary syndrome, body composition, fat loss, weight loss, African American women, European American women, beta-cell function, fasting blood glucose
MeSH terms
Adult, Blood Glucose, Body Composition, Body Weight, Energy Intake, Diabetes Mellitus, Type 2, Fasting, Female, Food Handling, Humans, Inflammation, Insulin, Insulin Resistance, Islets of Langerhans, Male, Middle Aged, Obesity, Polycystic Ovary Syndrome, Risk Factors, Biomarkers, Cross-Over Studies, Diet, Fat-Restricted, Abdominal Fat, Overweight, Diet, High-Fat

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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