Metabolic syndrome scores: Gender differences in low-calorie diet benefits

08 Aug 2018 --- A low-calorie diet causes different metabolic effects in women than in men, a new Diabetes, Obesity and Metabolism study suggests. In the study of more than 2,000 overweight individuals with pre-diabetes who followed a low-calorie diet for 8 weeks, men lost significantly more body weight than women, and they had larger reductions in a metabolic syndrome score, a diabetes indicator, fat mass and heart rate.

Women had larger reductions in HDL-cholesterol, hip circumference, lean body mass (or fat-free mass), and pulse pressure than men.

"Despite adjusting for the differences in weight loss, it appears that men benefited more from the intervention than women. Whether differences between genders persist in the long-term and whether we will need to design different interventions depending on gender will be interesting to follow," said lead author Dr. Pia Christensen, of the University of Copenhagen, in Denmark. "However, the 8-week low-energy diet in individuals with pre-diabetes did result in the initial 10% weight loss needed to achieve major metabolic improvement in the first phase of a diabetes prevention program."

According to the authors, the PREVIEW lifestyle intervention study is, to date, the largest, multinational study concerning the prevention of type‐2 diabetes. The team hypothesized that the initial, fixed low‐energy diet (LED) would induce different metabolic outcomes in men vs women.

All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI ≥ 25 kg/m2) individuals with pre‐diabetes according to ADA‐criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat‐free mass (FFM) and metabolic syndrome Z‐score.

In total, 2,224 individuals (1,504 women, 720 men) attended the baseline visit and 2,020 (90.8%) completed the follow‐up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA‐IR decreased by 1.50 ± 0.15 in men and by 1.35 ± 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z‐score, C‐peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo‐glycaemia.

The conclusions were that an 8‐week LED induced different effects in women than in men. These findings are clinically important and suggest gender‐specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.

Funding was received from the EU 7th Framework Program (FP7/2007‐2013) under grant agreement no. 312057, The National Health and Medical Research Council – EU Collaborative Grant, AUS, The NZ Health Research Council (14/191) and the UoA Faculty Research Development Fund. The Cambridge Weight Plan, UK donated all products for the 8‐week Low‐Energy Diet period.