The primary outcome is between-group change in body weight (Table (Table1).1). Body weight is measured by the Dual-energy x-ray absorptiometry (DXA) procedure (Lunar iDXA, GE Healthcare Lunar, Buckinghamshire, United Kingdom) giving total body mass in kilograms. The secondary outcome measures include energy expenditure measured in a WRIC to calculate REE [28], body composition by DXA, body anthropometry (WC, hip circumference, height) and a range of metabolites related to SAA metabolism, other amino acids, lipid parameters, appetite hormones and gene expression profiles in adipose tissue to explore additional potential benefits of an SAA restricted diet. Methods and validation for measurements have been published for amino acid profiles [29], sulfur metabolite/aminothiol analyses including hydrogen sulfide (H2S) [30], total fatty acid profile [31], appetite hormones and adipokines [32, 33]. Glucose and insulin will be measured as part of the routine clinical laboratory panel for calculation of Homeostatic Model Assessment for Insulin Resistance (HOMA). This panel also includes C-peptide. Liver biomarkers including alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), lactate dehydrogenase (LD), creatine kinase (CK), alkalic phosphatases (ALP), gamma-glutamyltransferase (ɤ-GT) and the fatty liver index (based on BMI, WC, triglycerides and ɤ-GT) will be assessed to evaluate liver function and hepatic steatosis [34]. Nitrogen balance will be assessed using established methods [35, 36]. Outcome information will be collected at baseline, after 4 and at the final visit.

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