Summary: In 253 adults with overweight or obesity and prediabetes, a 25% isocaloric calorie-restricted diet lowered glucagon, amylin, peptide YY and GLP-1 and raised ghrelin, and these shifts were broadly similar across three dietary patterns. Larger reductions in amylin and GLP-1, or larger rises in ghrelin during restriction, were associated with greater weight regain over the following six months. These are within-trial associations, not a demonstrated treatment effect on weight maintenance.
PICO Summary
| Element | Detail |
|---|---|
| Population | 253 adults with overweight or obesity and prediabetes; randomized controlled trial, single-centre, China (ClinicalTrials.gov NCT03856762). |
| Intervention | 25% isocaloric calorie restriction for 6 months, delivered as a Traditional Jiangnan diet or a Mediterranean diet, with serum hormones measured at 0, 3 and 6 months and body weight reassessed 6 months after the intervention ended. |
| Comparison | A 25% isocaloric calorie-restricted Control diet arm; all three arms were calorie restricted, so the comparison was between dietary patterns rather than against an unrestricted diet. |
| Outcome | At 3 months, fasting and post-glucose-load glucagon, amylin, peptide YY and GLP-1 fell while ghrelin rose, with most changes sustained at 6 months and consistent across diets. During the intervention, reductions in glucagon, amylin and GLP-1 were positively associated with weight change and ghrelin was inversely associated. Larger reductions in amylin and GLP-1, or larger increases in ghrelin, during restriction were associated with greater post-intervention weight regain. The abstract reports directions of association only; no effect sizes, 95% confidence intervals, p-values or absolute risk reductions are given, and no significance testing is quoted for individual hormones. |
Expert Commentary
This is a mechanistic, hypothesis-generating analysis nested within a randomized dietary trial, and it should be read as associational rather than causal. The headline message is that calorie restriction produces a reproducible enteropancreatic hormone signature regardless of whether the diet is patterned on Jiangnan or Mediterranean traditions, and that the magnitude of that signature tracks with later weight regain. The verdict is that the biomarker concept is plausible and biologically coherent, but it is not yet actionable. The most important limitation is that the associations are derived from observed hormone changes within the trial, so they are vulnerable to confounding by the degree of weight loss itself and cannot establish that the hormone shifts cause regain. The single-centre Chinese population, the absence of reported confidence intervals or adjusted effect sizes in the abstract, and the involvement of a commercial institute among the authors all warrant caution, and there is no medication manufacturer driving the result. Can I use this with my patients? Not yet; there is no validated threshold of amylin, GLP-1 or ghrelin change that would let a clinician flag an individual as high risk for regain at the bedside. What I would like to see next is external replication with pre-specified, adjusted models and a clear predictive cut-off before any hormone panel is offered as a weight-maintenance risk tool.
References
Lin H, Wang Q, Gao A, Sun Y, Shen C, Chen Y, et al. Enteropancreatic hormone changes in caloric-restricted diet interventions associate with post-intervention weight maintenance. Clin Nutr. 2024;43(12):5-14. doi:10.1016/j.clnu.2024.10.004
