Weight loss maintenance in overweight subjects on ad libitum diets with high or low protein content and glycemic index: the DIOGENES trial 12-month results

International Journal of Obesity, Springer Nature, ISSN 1476-5497

Volume 38, 12, 2014

DOI:10.1038/ijo.2014.52, Dimensions: pub.1039124690, PMID: 24675714,


Claus, H (3)
Martinez, J A (7) (8)
Stender, S (11)
Astrup, A (2)

* Corresponding author



  1. (1) Maastricht University Medical Centre, grid.412966.e
  2. (2) University of Copenhagen, grid.5254.6, KU
  3. (3) Institute of Preventive Medicine, Centre for Health and Society, Copenhagen, Denmark
  4. (4) MRC Human Nutrition Research, grid.415055.0
  5. (5) University of Crete, grid.8127.c
  6. (6) German Institute of Human Nutrition, grid.418213.d
  7. (7) Institute of Health Carlos III, grid.413448.e
  8. (8) University of Navarra, grid.5924.a
  9. (9) National Multiprofile Transport Hospital, Sofia, Bulgaria
  10. (10) Institute of Endocrinology, grid.418976.5
  11. (11) Gentofte Hospital, grid.411646.0, Capital Region


BACKGROUND: A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce. OBJECTIVE: The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year. METHOD: After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27 kg m(-)(2)) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period. RESULTS: During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0-4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups. CONCLUSION: A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months.


Research Categories

Main Subject Area

Fields of Research

Links & Metrics

NORA University Profiles

University of Copenhagen

Danish Open Access Indicator

2014: Unused

Research area: Science & Technology

Danish Bibliometrics Indicator

2014: Level 1

Research area: Science & Technology

Dimensions Citation Indicators

Times Cited: 77

Field Citation Ratio (FCR): 18.91

Relative Citation ratio (RCR): 2.91