תזונה ותוספים Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet

[Mike Bikov]

Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate
Versus Low-Fat Diet A Randomized Trial

Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD; Angela P. Makris, PhD, RD; Diane L. Rosenbaum, BA; Carrie Brill, BS;
Richard I. Stein, PhD; B. Selma Mohammed, MD, PhD; Bernard Miller, MD; Daniel J. Rader, MD; Babette Zemel, PhD;
Thomas A. Wadden, PhD; Thomas Tenhave, PhD; Craig W. Newcomb, MS; and Samuel Klein, MD

Background: Previous studies comparing low-carbohydrate and
low-fat diets have not included a comprehensive behavioral treatment,
resulting in suboptimal weight loss.

Objective: To evaluate the effects of 2-year treatment with a
low-carbohydrate or low-fat diet, each of which was combined
with a comprehensive lifestyle modification program.
Design: Randomized parallel-group trial. (ClinicalTrials.gov registration
number: NCT00143936)

Setting: 3 academic medical centers.

Patients: 307 participants with a mean age of 45.5 years (SD, 9.7
years) and mean body mass index of 36.1 kg/m2 (SD, 3.5 kg/m2).

Intervention: A low-carbohydrate diet, which consisted of limited
carbohydrate intake (20 g/d for 3 months) in the form of low–
glycemic index vegetables with unrestricted consumption of fat and
protein. After 3 months, participants in the low-carbohydrate diet
group increased their carbohydrate intake (5 g/d per wk) until a
stable and desired weight was achieved. A low-fat diet consisted of
limited energy intake (1200 to 1800 kcal/d; !30% calories from
fat). Both diets were combined with comprehensive behavioral
treatment.

Measurements: Weight at 2 years was the primary outcome. Secondary
measures included weight at 3, 6, and 12 months and
serum lipid concentrations, blood pressure, urinary ketones, symptoms,
bone mineral density, and body composition throughout the
study.

Results: Weight loss was approximately 11 kg (11%) at 1 year and
7 kg (7%) at 2 years. There were no differences in weight, body
composition, or bone mineral density between the groups at any
time point. During the first 6 months, the low-carbohydrate diet
group had greater reductions in diastolic blood pressure, triglyceride
levels, and very-low-density lipoprotein cholesterol levels, lesser reductions
in low-density lipoprotein cholesterol levels, and more
adverse symptoms than did the low-fat diet group. The lowcarbohydrate
diet group had greater increases in high-density
lipoprotein cholesterol levels at all time points, approximating a
23% increase at 2 years.

Limitation: Intensive behavioral treatment was provided, patients
with dyslipidemia and diabetes were excluded, and attrition at 2
years was high.
Conclusion: Successful weight loss can be achieved with either a
low-fat or low-carbohydrate diet when coupled with behavioral
treatment. A low-carbohydrate diet is associated with favorable
changes in cardiovascular disease risk factors at 2 years.
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