High-protein, low-glycaemic meal replacement decreases fasting insulin and inflammation markers—a 12-month subanalysis of the acoorh trial

Kerstin Kempf, Martin Röhling, Winfried Banzer, Klaus Michael Braumann, Martin Halle, David McCarthy, Hans Georg Predel, Isabelle Schenkenberger, Susanne Tan, Hermann Toplak, Aloys Berg, Stephan Martin

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Lifestyle interventions, including meal replacement, are effective in the prevention and treatment of type-2-diabetes and obesity. Since insulin is the key weight regulator, we hypothesised that the addition of meal replacement to a lifestyle intervention reduces insulin levels more effectively than lifestyle intervention alone. In the international multicentre randomised controlled ACOORH (Almased Concept against Overweight and Obesity and Related Health Risk) trial, overweight or obese persons who meet the criteria for metabolic syndrome (n = 463) were randomised into two groups. Both groups received nutritional advice focusing on carbohydrate restriction and the use of telemonitoring devices. The intervention group substituted all three main meals per day in week 1, two meals per day in weeks 2–4, and one meal per day in weeks 5–26 with a protein-rich, low-glycaemic meal replacement. Data were collected at baseline and after 1, 3, 6 and 12 months. All datasets providing insulin data (n = 446) were included in this predefined subanalysis. Significantly higher reductions in insulin (−3.3 ± 8.7 µU/mL vs. −1.6 ± 9.8 µU/mL), weight (−6.1 ± 5.2 kg vs. −3.2 ± 4.6 kg), and inflammation markers were observed in the intervention group. Insulin reduction correlated with weight reduction and the highest amount of weight loss (−7.6 ± 4.9 kg) was observed in those participants with an insulin decrease > 2 µU/mL. These results underline the potential for meal replacement-based lifestyle interventions in diabetes prevention, and measurement of insulin levels may serve as an indicator for adherence to carbohydrate restriction.

Original languageEnglish
Article number1433
Issue number5
StatePublished - May 2021
Externally publishedYes


  • Fasting insulin
  • Lifestyle intervention
  • Low-carbohydrate
  • Low-glycaemic meal replacement
  • Multicentre study
  • Obesity
  • Overweight
  • Protein-rich
  • RCT
  • Weight reduction


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