Effects of low-carbohydrate and low-fat diets: a randomized trial.

BACKGROUND Low-carbohydrate diets are popular for weight loss, but their cardiovascular effects have not been well-studied, particularly in diverse populations. OBJECTIVE To examine the effects of a low-carbohydrate diet compared with a low-fat diet on body weight and cardiovascular risk factors. DESIGN A randomized, parallel-group trial. (ClinicalTrials.gov: NCT00609271). SETTING A large academic medical center. PARTICIPANTS 148 men and women without clinical cardiovascular disease and diabetes. INTERVENTION A low-carbohydrate (<40 g/d) or low-fat (<30% of daily energy intake from total fat [<7% saturated fat]) diet. Both groups received dietary counseling at regular intervals throughout the trial. MEASUREMENTS Data on weight, cardiovascular risk factors, and dietary composition were collected at 0, 3, 6, and 12 months. RESULTS Sixty participants (82%) in the low-fat group and 59 (79%) in the low-carbohydrate group completed the intervention. At 12 months, participants on the low-carbohydrate diet had greater decreases in weight (mean difference in change, -3.5 kg [95% CI, -5.6 to -1.4 kg]; P = 0.002), fat mass (mean difference in change, -1.5% [CI, -2.6% to -0.4%]; P = 0.011), ratio of total-high-density lipoprotein (HDL) cholesterol (mean difference in change, -0.44 [CI, -0.71 to -0.16]; P = 0.002), and triglyceride level (mean difference in change, -0.16 mmol/L [-14.1 mg/dL] [CI, -0.31 to -0.01 mmol/L {-27.4 to -0.8 mg/dL}]; P = 0.038) and greater increases in HDL cholesterol level (mean difference in change, 0.18 mmol/L [7.0 mg/dL] [CI, 0.08 to 0.28 mmol/L {3.0 to 11.0 mg/dL}]; P < 0.001) than those on the low-fat diet. LIMITATION Lack of clinical cardiovascular disease end points. CONCLUSION The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors. PRIMARY FUNDING SOURCE National Institutes of Health.

[1]  Jiang He,et al.  Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. , 2012, American journal of epidemiology.

[2]  C. Ebbeling,et al.  Effects of dietary composition on energy expenditure during weight-loss maintenance. , 2012, JAMA.

[3]  H. Adami,et al.  Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study , 2012, BMJ : British Medical Journal.

[4]  T. Wadden,et al.  Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet , 2010, Annals of Internal Medicine.

[5]  G. Brinkworth,et al.  Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. , 2009, The American journal of clinical nutrition.

[6]  J. Wylie-Rosett,et al.  Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes , 2009, Diabetes Care.

[7]  B. Yawn,et al.  Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. , 2009 .

[8]  K. Resch [Dietary Intervention Randomized Controlled Trial (DIRECT) group: weight loss with a low-carbohydrate, Mediterranean, or low-fat diet]. , 2008, Forschende Komplementarmedizin.

[9]  M. Stampfer,et al.  Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. , 2008, The New England journal of medicine.

[10]  Geert Molenberghs,et al.  Missing Data in Clinical Studies , 2007 .

[11]  H. Kraemer,et al.  Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. , 2007, JAMA.

[12]  J. Manson,et al.  Low-carbohydrate-diet score and the risk of coronary heart disease in women. , 2006, The New England journal of medicine.

[13]  N. Iqbal,et al.  The effects of a low-carbohydrate versus low-fat diet on adipocytokines in severely obese adults: three-year follow-up of a randomized trial. , 2006, European review for medical and pharmacological sciences.

[14]  L. Moretti,et al.  A Randomized Study Comparing the Effects of a Low-Carbohydrate Diet and a Conventional Diet on Lipoprotein Subfractions and C-reactive Protein Levels in Patients With Severe Obesity. , 2006, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[15]  Daniel W. Jones,et al.  Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. , 2005, Hypertension.

[16]  J. Griffith,et al.  Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. , 2005, JAMA.

[17]  E. Gracely,et al.  The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial , 2004, Annals of Internal Medicine.

[18]  D. Rader,et al.  A randomized trial of a low-carbohydrate diet for obesity. , 2003, The New England journal of medicine.

[19]  E. Gracely,et al.  A low-carbohydrate as compared with a low-fat diet in severe obesity. , 2003, The New England journal of medicine.

[20]  S. Daniels,et al.  A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. , 2003, The Journal of clinical endocrinology and metabolism.

[21]  J. Mckenney,et al.  National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) , 2002 .

[22]  N. Stone,et al.  Therapeutic lifestyle change and adult treatment panel III: Evidence then and now , 2002, Current atherosclerosis reports.

[23]  J W Erdman,et al.  AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. , 2000, Stroke.

[24]  R. Ross Atherosclerosis is an inflammatory disease , 1999 .

[25]  D. Levy,et al.  Prediction of coronary heart disease using risk factor categories. , 1998, Circulation.

[26]  R. Krauss,et al.  Association of small low-density lipoprotein particles with the incidence of coronary artery disease in men and women. , 1996, JAMA.

[27]  J. Larosa,et al.  Effects of high-protein, low-carbohydrate dieting on plasma lipoproteins and body weight. , 1980, Journal of the American Dietetic Association.

[28]  P. Fu,et al.  Enzymatic determination of total serum cholesterol. , 1974, Clinical chemistry.

[29]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[30]  Mark D. Huffman,et al.  Heart disease and stroke statistics--2013 update: a report from the American Heart Association. , 2013, Circulation.

[31]  D. Nieman,et al.  Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates , 2010 .

[32]  H. Wyatt,et al.  Correction: Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet , 2010 .

[33]  Lawrence J Appel,et al.  Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. , 2005, Hypertension.

[34]  D. Mitchell,et al.  The Minnesota Nutrition Data System , 1991 .

[35]  T. Schacker,et al.  Annals of Internal Medicine , 1992 .