Sex-Specific Variation in Metabolic Responses to Diet
Abstract
:1. Introduction
2. Methods
3. Macronutrient Ratios and Quality
3.1. Carbohydrates
3.2. Lipids
3.3. Protein
Author | Study Details | Participants | Findings | Limitations |
---|---|---|---|---|
Schulze [26] | Prospective cohort study, 8 to 10-year follow-up. Evaluated whether dietary carbohydrate content or substitution for other macronutrients predicted T2D. | n = 25,067 Primarily middle-aged adults without T2D at baseline. | Replacing 5% protein energy with carbohydrate reduced T2D risk in men only. | Carbohydrate quality not considered in substitution modeling. |
Vitale et al. [29] | 12-week clinical trial (parallel, randomized). Intervention: low- or high-glycemic index Mediterranean diet; both diets included carbohydrates (270 g/day) and fiber (35 g/day). Participants received dietary education and diet-specific carbohydrate foods. | n = 156 Middle-aged and older adults. Overweight and obese—WC > 102 cm for men and >88 cm for women. At least one additional feature of the metabolic syndrome. | ↑ 8 h baseline-adjusted mean plasma glucose concentrations following meal tolerance tests in women assigned high-GI vs. low-GI diet and within high-GI group before and after intervention. Men showed no differences. | Higher baseline WC, fasting BG, HOMA-IR, SBP, and triglycerides and lower HDL-C in men compared with women. |
Nanri et al. [31] | Prospective cohort study, 5-year follow-up. Evaluated whether intake of starch foods predicted T2D incidence. | n = 59,288 Middle-aged and older adults without T2D at baseline. | ↑ incidence of T2D in women consuming ≥ 3 bowls of white rice each day, not observed in men. | Diet measured once at baseline; T2D diagnosis based on self-report. |
Kanehara et al. [32] | Prospective cohort study, 5-year follow-up. Evaluated whether intake of refined carbohydrate foods predicted T2D incidence. | n = 64,677 Mostly healthy middle-aged and older adults. | ↑ incidence of type 2 in women with high intake of total sugar, fructose, and starch, men showed no association. | T2D diagnosis based on self-report. |
Nanri et al. [55] | Prospective cohort study, 5-year follow-up. Evaluated effect of plant and animal protein intake on T2D incidence in men and women. | n = 64,674 Middle aged to older adults without history of T2D or other major chronic diseases. | ↓ risk of T2D in women consuming low-carbohydrate, high-animal protein diet, but not in men. | T2D diagnosis based on self-report. Dietary intake was only measured once; did not include data on covariates such as physical activity and SES. |
Kovar et al. [35] | Clinical trial (crossover, non-randomized). Intervention: participants consumed low-fat diet followed by high-fat, high-cholesterol diet for 2 weeks each. | n = 10 Healthy young adults, normal BMI. | ↑ in LDL-C and HDL-C cholesterol more pronounced in women vs. Men. ↑ postprandial triglyceridemia in men on high-fat diet. | Diet order not randomized and no washout period; diets were self-selected and compliance was based on self-report. |
Niinikoski et al. [37] | Clinical trial (randomized, parallel). Intervention: infants aged 7 to 36 months assigned to typical diet or diet low in cholesterol and saturated fat with energy contributions of 10–15% protein, 50–60% carbohydrates, and 30–35% fat. Both groups were visited 10 times by the study’s counseling team. | n = 1062 healthy infants enrolling at 7 months of age, continuing until 36 months. | Significant sex interaction for baseline-adjusted mean cholesterol; percent difference between control and intervention was +6% in boys, +3% in girls. | Food intake and serving size parent-reported; parents and daycare center providers recorded food differently; unable to accurately obtain nutrient intake information for children that were breastfed < 13 months. |
Westerterp-Plantenga et al. [54] | Clinical trial (crossover, randomized). Intervention: during each experimental period, participants spent 3 days in a whole-room calorimeter. Adequate-protein diet: energy provided was 10% protein, 60% carbohydrates, and 30% fat High-protein diet: energy provided was 30% protein, 40% carbohydrates, 30% fat. | n = 10 Healthy young adults. | High-protein diet promoted ↑ satiety in women only. High-protein diet promoted greater ↑ energy expenditure and substrate oxidation in men compared with women. | Analysis of two separate trials rather than designed as one single trial. |
Farnsworth et al. [42] | Clinical trial (parallel, randomized). Intervention: diets were energy-restricted for first 12 weeks followed by 4 weeks of energy balance. High-protein: energy provided was 27% protein, 44% carbohydrate, and 29% fat. Standard-protein: energy provided was 16% protein, 57% carbohydrate, and 27% fat. 60% of energy intake was met by supplied foods. | n = 57 Young and middle-aged adults with BMI ≥ 27. High fasting insulin concentration but otherwise generally healthy. | Men lost 2.5 kg fat-free mass on the high-protein diet, while women remained the same. | In total, 75% of participants were women; bodyweight and fasting plasma glucose concentrations were significantly greater in the men than in the women at baseline. |
Pathak et al. [44] | Clinical trial (randomized, parallel). Intervention: prescribed 8-week energy restricted to estimated 75% of energy needs with limited animal protein intake, leucine (3 g/day), or placebo. | n = 30 Young and middle-aged adults with elevated WC and meeting one additional metabolic syndrome criterion. | Males in the leucine group had a higher fat-free mass compared with placebo after 8 weeks, while females had no increase. | Leucine dose not adjusted for bodyweight; many fewer men than women. |
4. Mediterranean Diet
Author | Study Details | Participants | Findings | Limitations |
---|---|---|---|---|
Bedard et al. [59] | Clinical trial (single arm). Intervention: participants provided 4-week Mediterranean diet after 4-week controlled diet run-in. | n = 70 Young and middle-aged adults; premenopausal women; elevated LDL-C or total cholesterol–HDL-C ratio; at least one factor for metabolic disease | 2 h post OGTT insulin concentrations decreased more in men; fasting total cholesterol–HDL-C ratio, LDL-C–HDL-C ratio, apoA2 concentrations, and systolic blood pressure decreased in men only. | No control diet employed. |
Leblanc et al. [68] | Clinical trial (single arm). Intervention: self-selected 12-week Mediterranean diet with MI counseling; 35% fat, 45% carbohydrate, 18% protein, 2% alcohol (approximate). | n = 103 Young and middle-aged adults; pre-menopausal women; met one criterion for metabolic syndrome; slightly elevated LDL-C and mostly healthy otherwise. | ↓ lipids, % body fat, weight, and diastolic BP in men only. | Decreases in energy intake and saturated fat, and increase in fiber, higher in men over intervention and at 6-month follow-up compared with women. |
Jennings et al. [69] | Clinical trial (parallel, randomized). Intervention: assignment to usual diet or Mediterranean diet for 12 months. Wholegrain pasta, extra virgin olive oil, low-fat low-salt cheese, high-polyunsaturated fat margarine, and vitamin D supplements provided to Mediterranean diet arm. | n = 1128 Older adults. | ↓ systolic blood pressure and pulse pressure in men only. ↓ urinary 24 h sodium in men only. ↓ arterial stiffness (augmentation index) in women only. | While appropriate covariates were applied in modeling, it is not clear whether anti-hypertensive medication use or baseline diet differed between men and women. |
5. Western Diets
Author | Study Details | Participants | Findings | Limitations |
---|---|---|---|---|
Perreault et al. [77] | Clinical trial (secondary analysis of DPP intervention and placebo arms [86]). Intervention: Reduced-calorie, low-fat diet; 150 min/week moderate physical activity; 1-year follow-up | n = 3000 Age ≥ 25 years, BMI ≥ 24, met diagnostic criteria for prediabetes. | 3–7% weight loss showed greater reduction in 2 h OGTT glucose/insulin and insulin resistance in men than in women; >7% weight loss showed greater reduction in 2 h OGTT and hemoglobin A1C in men compared with women. | Men had a greater load of baseline risk factors compared with women; no supervised intervention. |
Li et al. [78] | Clinical trial (crossover, non-randomized). Intervention: 6-week American-style diet was followed by 2–7-week washout and the TLC diet for 6 weeks. TLC diet: energy distribution of 16% protein, 58% carbohydrate, 25% fat, 4% saturated fat, and 45 mg cholesterol/4.2 MJ. American diet: energy distribution of 15% protein, 49% carbohydrate, 35% fat, 14% saturated fat, and 147 mg cholesterol/4.2 MJ. | n = 33 Middle-aged and older adults with moderate hypercholesterolemia but otherwise healthy; postmenopausal women. | ↑ fasting triglycerides following TLC in women but not in men; ↓ in postprandial triglyceride concentration in men but not women; total cholesterol–HDL-C ratio in men decreased by 5%, while women showed a 5% increase. | Men and women not evaluated in same statistical model; only within-sex group t-tests were used. |
Satija et al. [84] | Prospective cohort study, 22- and 26-year follow up. Compared outcomes between lowest and highest deciles of three plant-based diet indices: PDI, hPDI, and uPDI. | n = 209,928 Mostly healthy middle-aged and older adult health professionals. | ↑ CHD with high uPDI score appeared greater in women compared with men (hazard ratio 1.6 vs. 1.18 in top decile, for women and men, respectively). | No direct statistical comparison between men and women; self-reported data. |
6. Very Low-Calorie Diets
Author | Diet Type and Composition | Participants | Findings | Limitations |
---|---|---|---|---|
Christensen et al. [87] | Clinical trial (single arm). Intervention: 810 kcal, 85 g protein, 5 g essential fatty acids, and 13 g fiber each day | n = 2020 Adults with prediabetes, BMI ≥ 25. | Men showed more reduced metabolic syndrome Z-scores and fat mass compared with women even after adjusting for weight loss; women lost twice as much fat-free mass as men. | Dropout rates varied between sites and were lower among men; significantly greater relative energy deficit for men. |
Trouwborst et al. [88] | Clinical trial (secondary analysis). Intervention: 8-week 800 kcal/day, followed by 6-month phase with ad libitum diet. | n = 555 Overweight and obese adults under 65 years of age with fasting blood glucose concentrations < 6.1 mmol/L. | Men showed greater reductions in weight, insulin sensitivity, TAG, and LDL-C after adjusting for weight loss, but weight and cardiometabolic indicators rebounded more in the follow-up period compared with women. | High dropout rate; did not report body composition measures; 5 experimental arms of ad libitum phase after VLCD may have affected follow-up outcomes; significantly greater relative energy deficit for men. |
Tremblay et al. [89] | Clinical trial (secondary analysis of VLCD diet phase). Intervention: 800 kcal/day, 15–20% fat, 35–40% protein, 45–50% carbohydrate for 8 weeks. | Overweight and obese adults with impaired glucose tolerance. | Males showed greater reductions in fat mass, body fat percentage, and waist circumference compared with women in the 8-week weight-loss phase. | Significantly greater relative energy deficit for men. |
7. Limitations
8. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Andrews, R.R.; Anderson, K.R.; Fry, J.L. Sex-Specific Variation in Metabolic Responses to Diet. Nutrients 2024, 16, 2921. https://doi.org/10.3390/nu16172921
Andrews RR, Anderson KR, Fry JL. Sex-Specific Variation in Metabolic Responses to Diet. Nutrients. 2024; 16(17):2921. https://doi.org/10.3390/nu16172921
Chicago/Turabian StyleAndrews, Reya R., Kayla R. Anderson, and Jean L. Fry. 2024. "Sex-Specific Variation in Metabolic Responses to Diet" Nutrients 16, no. 17: 2921. https://doi.org/10.3390/nu16172921