Department of Kinesiology, The Ohio State University, Columbus, Ohio, United States of America.
Metagenics, Inc., Aliso Viejo, California, United States of America.
PLoS One. 2024 Aug 16;19(8):e0293670. doi: 10.1371/journal.pone.0293670. eCollection 2024.
Weight loss can positively alter female physiology; however, whether dietary carbohydrate- or fat- restriction confer unique effects is less studied. Precisely designed, hypocaloric well-formulated ketogenic diets (KD; ~75% energy for weight maintenance) were compared to isocaloric/isonitrogenous low-fat diet (LFD) on self-reported menses in pre-menopausal overweight and obese women (mean ± SD: 34 ± 10 years, BMI: 32.3 ± 2.7 kg/m2). Women received a precisely-weighed and formulated KD with either twice-daily with ketone salts (KS; n = 6) or a flavor-matched placebo (PL; n = 7) daily for six-weeks. An age and BMI-matched cohort (n = 6) was later assigned to the LFD and underwent the same testing procedures as the KD. Self-reported menses fluctuations were assessed bi-weekly along with measures of body weight, body composition, and fasting serum clinical chemistries using repeated measures ANOVA with Bonferroni post-hoc corrections. Both diets elicited clinically-significant weight-loss (Δ: -7.0 ± 0.5 kg; p < 0.001), primarily from fat-mass (Δ: -4.6 ± 0.3 kg; p < 0.001), and improved insulin-sensitivity and serum lipids (all p < 0.05). Fasting plasma glucose and inflammatory markers were not different between diets. Fasting capillary beta-hydroxybutyrate (R-βHB) increased significantly during the KD, independent of supplementation (Δ: 1.2 ± 0.3 mM R-βHB; p < 0.001). Women randomized to the KD+KS (30%) and KD+PL (43%) reported subjective increases in menses frequency and intensity after 14 days, whereas another third reported a regain of menses (>1 year since the last period) after 28 days. No LFD participants reported menses changes. Nutrient-dense, whole-food KDs and LFD improved weight, BMI, body composition, and blood parameters in pre-menopausal women after six-weeks. Changes in self-reported menses were described by most of the KD participants, but none of the LFD women suggesting there may be unique effects of nutritional ketosis, independent of weight loss.
体重减轻可以积极改变女性的生理机能；然而，饮食中碳水化合物或脂肪限制是否会产生独特的影响，这方面的研究还比较少。本研究精确设计了热量限制的、配方良好的生酮饮食（KD；用于维持体重的能量约为 75%），并与等热量/等氮的低脂饮食（LFD）进行了比较，研究对象为绝经前超重和肥胖女性（平均年龄 ± 标准差：34 ± 10 岁，BMI：32.3 ± 2.7 kg/m2）。女性接受精确称重和配方的 KD，每日两次，分别用酮盐（KS；n = 6）或口味匹配的安慰剂（PL；n = 7），持续 6 周。随后，一组年龄和 BMI 匹配的女性（n = 6）被分配到 LFD 组，并接受与 KD 相同的检测程序。通过重复测量方差分析和 Bonferroni 事后检验，每两周评估一次自我报告的月经波动情况，同时评估体重、身体成分和空腹血清临床化学指标。两种饮食均引起了临床显著的体重减轻（Δ：-7.0 ± 0.5 kg；p < 0.001），主要来自脂肪量（Δ：-4.6 ± 0.3 kg；p < 0.001），并改善了胰岛素敏感性和血清脂质（均 p < 0.05）。两种饮食的空腹血浆葡萄糖和炎症标志物均无差异。在 KD 期间，空腹毛细血管 β-羟基丁酸（R-βHB）显著增加，与补充无关（Δ：1.2 ± 0.3 mM R-βHB；p < 0.001）。随机分配到 KD+KS（30%）和 KD+PL（43%）的女性在 14 天后报告月经频率和强度增加，而另外三分之一的女性在 28 天后报告恢复月经（上次月经后 >1 年）。没有 LFD 参与者报告月经变化。在绝经前女性中，富含营养的全食物 KD 和 LFD 在六周后改善了体重、BMI、身体成分和血液参数。大多数 KD 参与者描述了自我报告的月经变化，但没有 LFD 女性报告月经变化，这表明营养性生酮状态可能具有独特的影响，与体重减轻无关。
