Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : OE01 - OE06 Full Version

Influence of Protein Diet on Weight Change in Obesity: A Systematic Review


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51949.15852
Keng Sue Yin, Nur Aishah Che Roos, Justin Gnanou, Brinnell Caszo

1. Student, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia. 2. Senior Lecturer, Pharmacology Unit, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia. 3. Associate Professor, Department of Biochemistry, International Medical University, Kuala Lumpur, Malaysia. 4. Senior Lecturer, Department of Physiology, International Medical University, Kuala Lumpur, Malaysia.

Correspondence Address :
Justin Gnanou,
International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia.
E-mail: justingnanou@gmail.com

Abstract

Introduction: High protein in the diet has been shown to have a beneficial effect in promoting weight loss through its effect on satiety. This effect is mediated in part by the release of anorexigenic hormones which decrease subsequent food intake, leading to weight loss. A high protein content enhances muscle mass, has a higher thermogenic effect. The effect of a high protein meal on weight loss and satiety has been the subject of concern as only few studies are available. Therefore, the rationale of this review was to investigate the evidence supporting a relationship between protein content on weight loss and satiety in obese subjects.

Aim: The aim of this systematic review was to compare the effect of high dietary protein versus normal protein content or non protein diet on both weight loss and satiety in obesity.

Materials and Methods: In this systematic review, the studies were identified by searching Ovid Medline, Scopus, PubMed, and Evidence Based Medicine (EBM)-review Cochrane database and was restricted to English language only, from the inception until 10th June 2019. Studies which were included fulfilled the following criteria: Randomised Controlled Trial (RCT) duration of atleast 3 weeks; subject age ≥18-year-old; obese or overweight subject whose Body Mass Index (BMI) ≥25; composition of protein diet of 20-30%; satiety assessment by the Visual Analogue Scale (VAS) and Satiety Quotient (SQ); report on the mean difference of weight loss.

Results: Total 727 studies were screened, eleven studies were selected as they fulfilled the inclusion criteria. In the overall analysis, five studies revealed a significant difference in satiety measurement while only three studies had observed significant difference in weight loss. The remaining studies showed a similar mean weight loss and satiety outcome achieved in both the control and intervention groups.

Conclusion: The present systematic review demonstrated that the high protein content in the diet shows no significant effect on weight loss and satiety. However, it is important to note that though weight loss is mainly due to energy restriction, high protein in diet could influence satiety and thus both can complement each other.

Keywords

Dietary intervention, Energy balance, Energy restriction, Obesity, Satiety quotient

High dietary protein has been well known and recognised to produce higher satiating effects than carbohydrate and fat by stimulating the released of satiety hormones (1),(2),(3). Upon ingesting any protein meal, the hypothalamus will detect the entry of amino acids, thereby stimulating the endocrine cells in colon and ileum to increase the production of Glucagon-Like Peptide-1 (GLP-1) and Peptide YY (PYY) hormones (4),(5),(6). These orexigenic hormones play a role in decreased subsequent food intake, leading to weight loss. Furthermore, not only protein meal assist in the development of lean body mass, but it also increases the body thermogenesis mediated via multiple metabolic processes (e.g., gluconeogenesis, deamination, and urea formation) involved in breaking down of protein meal (7),(8),(9),(10).

Failure in adhering to energy-restricted diets due to the feeling of hunger has always been one of the major concerns in compliance with weight-loss diet interventions in obesity since inducing weight loss requires achieving negative energy balance (11),(12). Hence, by achieving satiety, obese participants may consume less subsequent food which will facilitate weight loss (13),(14),(15),(16). Besides, this strategy will also heavily influence eating behaviour as it influences the self-regulation of food intake (17),(18),(20).

Interestingly, many studies have been done to determine the influence of dietary protein on body weight loss (21),(22),(23), but not many studies were done to relate both weight loss and satiety outcome in obesity [12[,]24]. This is because many short-term studies had been done to link satiety and food intake instead and fewer studies were conducted to determine the relationship between satiety, reduced energy intake and weight loss in the longer term (25),(24),(35). These studies have yet to be systematically reviewed to evaluate the role of dietary protein on both weight loss and satiety in obesity.

Therefore, this research aims to investigate the evidence supporting the effect of protein content on weight loss and satiety in obese subjects. To the best of our knowledge, this is the first systematic review, done to investigate the effect of high dietary protein on weight loss and satiety in obesity.

Material and Methods

A systematic review was conducted on four different databases which were Ovid Medline, Scopus, PubMed and EBM-review Cochrane.

Inclusion and Exclusion criteria: The inclusion and exclusion criteria were determined according to the Population, Intervention, Control and Outcomes (PICO) framework (Table/Fig 1) and a list of keywords was established and used to conduct the literature search (Table/Fig 2).

Search Strategy

A comprehensive search was performed using electronic databases including Ovid Medline, Scopus, PubMed, and EBM-review Cochrane from inception until 10th June 2019. The last search was performed on 10th June 2019. The search terms used were as follows: “protein diet” AND (“weight change” OR “weight loss” OR “weight reduction” OR “changes in body composition”) AND {“obesity” OR “overweight” OR “fat distribution” OR “body fat mass” OR “fat free mass” OR “Body Mass Index (BMI) “} AND (“satiety” OR “fullness” OR “frequency of eating” OR “hunger suppression.” The full search strategy is detailed in (Table/Fig 2). References of the eligible studies and relevant systematic review were also manually screened for other eligible studies. The search for eligible studies was not restricted in terms of publication period or geographical setting.

Study Criteria and Selection

Studies that met the following criteria were included: (i) Population: adult, overweight or obese regardless of sex and race; (ii) Intervention: high protein diet consisting of meat, dairy products, nuts, or certain grains and beans given as a main meal, snack, or supplement for atleast 3 weeks. The protein composition must be atleast 20-30% of the total dietary composition. In studies comparing two type of protein diet, a dietary protein with a higher composition was considered as the study intervention; (iii) Comparator: Low or normal protein intake prescribed similarly to the intervention as defined above. Comparison to a non protein diet was also considered in this review; (iv) Study design: RCTs with atleast two parallel arms comparing high protein versus low or non protein diet; (v) Able to report primary outcome measures: weight changes, and satiety measured by validated method e.g., visual analogue scale and Satiety Quotient (SQ). Additional outcome considered included BMI changes and energy expenditure.

The exclusion criteria were as follows: (i) Population: subjects with underlying genetic disorder, Cushing syndrome, hyperinsulinemia, or subjects who have undergone a surgical procedure such as bariatric surgery. Pregnant subjects were also excluded; (ii) Other intervention and comparator protocol used; (iii) Study duration less than three weeks and study design other than RCTs (e.g., prospective or retrospective observational studies, reviews, experimental studies, and editorial) including abstract and conference proceeding; (iv) Studies with insufficient data or information and failed to report the outcome of interest.

To ensure no potential paper was overlooked, the references in any reviews were also screened. Duplicates were then removed from the study. The titles and abstract were independently reviewed for eligibility by two researchers (SY and BC). The full texts of eligible articles were assessed, and any disagreement were discussed with a third reviewer (JG) until a consensus was reached. The screening and selection process of the included studies is summarised in (Table/Fig 3). The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines (36).

Data Extraction and Management

Data extraction into a pre-piloted and standardised form was performed independently by two reviewers (SY and BC). Study characteristics, including first author, geographical setting, participant’s demographic information (e.g., mean age, underlying co-morbidity, proportion of gender), study duration, intervention and comparator used, were extracted. Primary outcomes (mean or percentage of weight changes, and satiety measured by validated method) were also extracted. Additionally, changes in BMI and energy expenditure were extracted. In case of missing or incomplete information, the respective author was contacted by email to request for the missing data if necessary.

Quality Assessment

The methodological quality of the included studies was evaluated using the Cochrane Risk of Bias tool for RCT (RoB 2) (37). The tool consisted of five domains which recommend the reporting of the randomisation process, blinding of participants/personnel/outcome assessor, completeness and selectiveness of outcome reporting. Each domain was judged as at being a “high”, “low” or “unclear” RoB. If all the domains were judged to be “low”, the overall RoB for a particular study was deemed as low. If any of the domain was judged as “high”, the overall RoB for a particular study was deemed as high or unclear RoB (Table/Fig 4),(Table/Fig 5) (34),(35),(38),(39),(40),(41),(42),(43),(44),(45),(46). Two reviewers (SY and NA) independently assessed the quality of each included study. Any conflict was discussed with a third reviewer (BC) until a consensus was reached.

Data Synthesis

The study characteristics and methodological quality were summarised and tabulated. A meta-analysis was not performed because the intervention and comparator used were highly heterogeneous.

Results

After the screening process, which is detailed in (Table/Fig 3) only 11 articles were included in this review. The selected studies varied among one another in terms of intervention features which include dietary protein content, source of protein, intervention duration, and level of energy restriction. Three studies restricted their participants to consume 1500-1700 kcal/day (34),(38),(39), while four studies reduced the participants’ energy intake by 200-750 kcal (35),(40),(41),(42). There were three studies that did not have energy restriction diet (43),(44),(45) while one study (46) prescribed ad libitum diet.

Furthermore, across the selected studies, the protein content consumed in control group ranged from 10-18% or 0.8 g/kg/day while high protein group consumed 20-30% or 1.2-1.4g/kg/day of protein. The end of study measurement was obtained after the end of study intervention ranging from six weeks to two years in nine studies while two studies measured after the end of the energy restriction period. The summary of the study characteristics of the selected studies are tabulated in (Table/Fig 6).

Discussion

In this study, authors systematically reviewed studies that investigated the effect of high dietary protein on satiety and weight loss. Contrary to our expectations, most of the studies did not show a significant difference in both weight loss and satiety outcome. Among these eleven studies, five studies showed significant differences in satiety (35),(40),(41),(43),(45). This can be explained by the decrease in concentration of ghrelin upon consuming high protein meal compared to a normal protein meal. However, despite achieving satiety in the intervention group, there was no significant difference in weight loss. One possibility for no effect on weight loss could be due to non adherence (e.g., consuming higher calories intake than recommended) among the participants as reported in Rabinovitz HR et al., Baer DJ et al., and Pal S et al., conducted a protein supplement trial, with no energy restriction on the subjects and found a similar finding where the subjects in high protein group had significant decrease consumption of carbohydrate (p-value <0.05) compared to control group (41),(44),(45). This result has supported the protein leverage hypothesis and may provide a significant finding in consuming protein supplements for achieving weight maintenance in long term.

Additionally, the two studies done by Leidy HJ et al., in (2007) and (2011) used a different source of protein in both the control and intervention groups (35),(40). The high protein group consumed animal protein while the normal protein group consumed milk and showed that higher protein (animal protein) had a better satiating effect than (normal protein) milk. However, the study design in these studies did not conclusively prove the effect of the source of protein as an important factor in inducing satiety (35),(40). Furthermore, a high adherence rate in high protein group was observed compared to normal protein group which may conclude that high dietary protein is more satiating and may be useful in weight management programs in the long term.

In our review, authors also found a statistically significant weight loss as an effect of protein in the diet in three studies (34),(39),(44). However, in contrast to the previous studies, despite having significant weight loss, there was no significant change in satiety between control and intervention group in Nicols-Richardson SM et al., (2005) (39). The study suggested that the participants in the control group may have the capability to restraint hunger when there is a strong motivation to lose weight. We also observed that the high dietary protein group in these studies achieved significant weight loss due to the satiety effect of the high protein content. Thus, the subjects with high protein in diet managed to lose weight through subsequently reduced food intake, thus supporting our hypothesis on the effect of high dietary protein on weight loss and satiety. Although significant weight loss was not achieved, there was a significant change in body composition such as the percentage of fat mass and lean body mass in Leidy HJ et al., (2011) and Arguin H et al., (2017) studies, respectively (40),(43).

The remaining three of our included studies failed to achieve statistically significant changes in either satiety or weight loss (38),(42),(46). Although, there was a reasonably significant difference in perceived satiety among the subjects in Johnston CS et al., (2004), the satiety measurement used was qualitative (e.g., 7-point Likert scale), thus making it difficult to evaluate the satiety effect (38). Besides, consuming normal protein content may be sufficient to induce satiety as well. Furthermore, it is also possible that the weight loss achieved by both intervention and control group was due to energy restriction condition rather than the effect of macronutrient composition (38),(46). Also, having intensive behavioural counselling may be a key factor in motivating the participants to stay adhered to diet prescription and might result in successful weight loss, regardless of the type of diet (42).

Limitation(s)

There were several limitations to this review. First and most notable was the variety of different characteristics of the study protocols (i.e., source of protein, duration of intervention, level of energy restriction). Secondly, it was difficult to assess the quality of the experiment in most of the studies as clear details regarding methodology were not available. Thirdly, one of the studies did not comprehensively address the relationship between weight loss and satiety outcome since the priority of that study was to address the primary outcome which was the resting energy expenditure (46). Lastly, the evidence presented in this review is only as good as the quality of the studies included. In this systematic review the effects of the types of protein provided have not been taken into account. Since, the effect of the type of proteins consumed has been shown to have some effect on muscle adaptation and metabolic process, which in may have an effect on body composition, muscle mass and energy expenditure (47). In addition to this, an area which needs further exploration is the effect of age on satiety, hunger and energy balance (48). In children as well, satiety and appetite can be affected by the composition of diet and protein content (49). Hence, to take this work forwards, to areas which require systematic analysis of research done include the effect of the type of protein in the diet, and a consideration of age of the subjects and their interactions.

Conclusion

In conclusion, our systematic review demonstrated that high protein content of the diet shows no significant effect on weight loss and satiety. However, it is important to note that weight loss is mainly due to energy restriction, while a high protein in the diet could influence satiety and thus both can complement each other.

Acknowledgement

This study was supported by International Medical University Internal Grant (Project ID No: BP I-01-2019(03)).

BC was the principal investigator and was responsible for the original ideas of the project. SY and NA conducted the systematic review along with JG and BC. Data analysis was conducted by NA, SY and BC. The manuscript was edited and drafted by BC and JG.

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DOI and Others

DOI: 10.7860/JCDR/2022/51949.15852

Date of Submission: Aug 17, 2021
Date of Peer Review: Sep 15, 2021
Date of Acceptance: Oct 13, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

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