 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||
18 May 2004 | Volume 140 Issue 10 | Pages 778-785
Background: A previous paper reported the 6-month comparison of weight loss and metabolic changes in obese adults randomly assigned to either a low-carbohydrate diet or a conventional weight loss diet.
Objective: To review the 1-year outcomes between these diets.
Design: Randomized trial.
Setting: Philadelphia Veterans Affairs Medical Center.
Participants: 132 obese adults with a body mass index of 35 kg/m2 or greater; 83% had diabetes or the metabolic syndrome.
Intervention: Participants received counseling to either restrict carbohydrate intake to <30 g per day (low-carbohydrate diet) or to restrict caloric intake by 500 calories per day with <30% of calories from fat (conventional diet).
Measurements: Changes in weight, lipid levels, glycemic control, and insulin sensitivity.
Results: By 1 year, mean (±SD) weight change for persons on the low-carbohydrate diet was –5.1 ± 8.7 kg compared with –3.1 ± 8.4 kg for persons on the conventional diet. Differences between groups were not significant (–1.9 kg [95% CI, –4.9 to 1.0 kg]; P = 0.20). For persons on the low-carbohydrate diet, triglyceride levels decreased more (P = 0.044) and high-density lipoprotein cholesterol levels decreased less (P = 0.025). As seen in the small group of persons with diabetes (n = 54) and after adjustment for covariates, hemoglobin A1c levels improved more for persons on the low-carbohydrate diet. These more favorable metabolic responses to a low-carbohydrate diet remained significant after adjustment for weight loss differences. Changes in other lipids or insulin sensitivity did not differ between groups.
Limitations: These findings are limited by a high dropout rate (34%) and by suboptimal dietary adherence of the enrolled persons.
Conclusion: Participants on a low-carbohydrate diet had more favorable overall outcomes at 1 year than did those on a conventional diet. Weight loss was similar between groups, but effects on atherogenic dyslipidemia and glycemic control were still more favorable with a low-carbohydrate diet after adjustment for differences in weight loss.
Editors' Notes
Context
Contribution
Cautions
–The Editors
Author and Article Information
From Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Medical Center, and Drexel University College of Medicine, Philadelphia, Pennsylvania.
Acknowledgment: The authors thank Dr. Stephen E. Kimmel and Dr. David Asch for their detailed review and comments on this manuscript, as well as Dr. Justine Shults for her valuable consultation on the statistical analyses.
Grant Support: By the Veterans Affairs Healthcare Network Competitive Pilot Project Grant.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Frederick F. Samaha, MD, Cardiology, 8th Floor, MC 111C, Philadelphia Veterans Affairs Medical Center, University and Woodland Avenue, Philadelphia, PA 19104; e-mail, rick.samaha{at}med.va.gov.
Current Author Addresses: Drs. Stern, Iqbal, Seshadri, and Samaha, Ms. Chicano, Ms. Daily, Ms. McGrory, and Ms. Williams: Philadelphia Veterans Affairs Medical Center, Cardiology, 8th Floor MC 111C, University and Woodland Avenues, Philadelphia, PA 19104.
Dr. Gracely: Family, Community, and Preventive Medicine, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129.
Author Contributions: Conception and design: L. Stern, N. Iqbal, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, E.J. Gracely, F.F. Samaha.
Analysis and interpretation of the data: P. Seshadri, E.J. Gracely, F.F. Samaha.
Drafting of the article: L. Stern, N. Iqbal, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, F.F. Samaha.
Critical revision of the article for important intellectual content: L. Stern, N. Iqbal, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, E.J. Gracely, F.F. Samaha.
Final approval of the article: L. Stern, N. Iqbal, P. Seshadri, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, E.J. Gracely, F.F. Samaha.
Provision of study materials or patients: L. Stern, N. Iqbal, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, F.F. Samaha.
Statistical expertise: E.J. Gracely, F.F. Samaha.
Obtaining of funding: L. Stern, N. Iqbal, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, F.F. Samaha.
Administrative, technical, or logistic support: F.F. Samaha.
Collection and assembly of data: L. Stern, N. Iqbal, P. Seshadri, K.L. Chicano, D.A. Daily, J. McGrory, M. Williams, F.F. Samaha. ARTICLE
The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  I. Shai, D. Schwarzfuchs, Y. Henkin, D. R. Shahar, S. Witkow, I. Greenberg, R. Golan, D. Fraser, A. Bolotin, H. Vardi, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet N. Engl. J. Med., July 17, 2008; 359(3): 229 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J de Souza, J. F Swain, L. J Appel, and F. M Sacks Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations Am. J. Clinical Nutrition, July 1, 2008; 88(1): 1 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden Approaches to Treatment of Pre-Diabetes and Obesity and Promising New Approaches to Type 2 Diabetes Diabetes Care, July 1, 2008; 31(7): 1461 - 1466. [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Bessesen Update on Obesity J. Clin. Endocrinol. Metab., June 1, 2008; 93(6): 2027 - 2034. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Eckel Nonsurgical Management of Obesity in Adults N. Engl. J. Med., May 1, 2008; 358(18): 1941 - 1950. [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Janiszewski, T. J. Saunders, and R. Ross Themed Review: Lifestyle Treatment of the Metabolic Syndrome American Journal of Lifestyle Medicine, April 1, 2008; 2(2): 99 - 108. [Abstract] [PDF]
|
|
|
|
|
|
T. L Halton, S. Liu, J. E Manson, and F. B Hu Low-carbohydrate-diet score and risk of type 2 diabetes in women Am. J. Clinical Nutrition, February 1, 2008; 87(2): 339 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Tay, G. D. Brinkworth, M. Noakes, J. Keogh, and P. M. Clifton Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J. Am. Coll. Cardiol., January 1, 2008; 51(1): 59 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Beck and S. Richy Differential long-term dietary regulation of adipokines, ghrelin, or corticosterone: impact on adiposity J. Endocrinol., January 1, 2008; 196(1): 171 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Standards of Medical Care in Diabetes--2008 Diabetes Care, January 1, 2008; 31(Supplement_1): S12 - S54. [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association Diabetes Care, January 1, 2008; 31(Supplement_1): S61 - S78. [Full Text] [PDF]
|
|
|
|
|
|
C. E. O'Neil and T. A. Nicklas State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health American Journal of Lifestyle Medicine, December 1, 2007; 1(6): 457 - 481. [Abstract] [PDF]
|
|
|
|
 |
|
 B. A. Spear, S. E. Barlow, C. Ervin, D. S. Ludwig, B. E. Saelens, K. E. Schetzina, and E. M. Taveras Recommendations for Treatment of Child and Adolescent Overweight and Obesity Pediatrics, December 1, 2007; 120(Supplement_4): S254 - S288. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Pierce, V. A. Newman, L. Natarajan, S. W. Flatt, W. K. Al-Delaimy, B. J. Caan, J. A. Emond, S. Faerber, E. B. Gold, R. A. Hajek, et al. Telephone Counseling Helps Maintain Long-Term Adherence to a High-Vegetable Dietary Pattern J. Nutr., October 1, 2007; 137(10): 2291 - 2296. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. C Westman, R. D Feinman, J. C Mavropoulos, M. C Vernon, J. S Volek, J. A Wortman, W. S Yancy, and S. D Phinney Low-carbohydrate nutrition and metabolism Am. J. Clinical Nutrition, August 1, 2007; 86(2): 276 - 284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Fowler Diabetes Treatment, Part 1: Diet and Exercise Clin. Diabetes, July 1, 2007; 25(3): 105 - 109. [Full Text] [PDF]
|
|
|
|
|
|
T. McLaughlin, S. Carter, C. Lamendola, F. Abbasi, P. Schaaf, M. Basina, and G. Reaven Clinical Efficacy of Two Hypocaloric Diets That Vary in Overweight Patients With Type 2 Diabetes: Comparison of moderate fat versus carbohydrate reductions Diabetes Care, July 1, 2007; 30(7): 1877 - 1879. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Focardi, G. M. Dick, A. Picchi, C. Zhang, and W. M. Chilian Restoration of coronary endothelial function in obese Zucker rats by a low-carbohydrate diet Am J Physiol Heart Circ Physiol, May 1, 2007; 292(5): H2093 - H2099. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Das, C. H Gilhooly, J. K Golden, A. G Pittas, P. J Fuss, R. A Cheatham, S. Tyler, M. Tsay, M. A McCrory, A. H Lichtenstein, et al. Long-term effects of 2 energy-restricted diets differing in glycemic load on dietary adherence, body composition, and metabolism in CALERIE: a 1-y randomized controlled trial Am. J. Clinical Nutrition, April 1, 2007; 85(4): 1023 - 1030. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. K. Mahon, M. G. Flynn, L. K. Stewart, B. K. McFarlin, H. B. Iglay, R. D. Mattes, R. M. Lyle, R. V. Considine, and W. W. Campbell Protein Intake during Energy Restriction: Effects on Body Composition and Markers of Metabolic and Cardiovascular Health in Postmenopausal Women J. Am. Coll. Nutr., April 1, 2007; 26(2): 182 - 189. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Gardner, A. Kiazand, S. Alhassan, S. Kim, R. S. Stafford, R. R. Balise, H. C. Kraemer, and A. C. King 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 JAMA, March 7, 2007; 297(9): 969 - 977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C Maki, T. M Rains, V. N Kaden, K. R Raneri, and M. H Davidson Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults Am. J. Clinical Nutrition, March 1, 2007; 85(3): 724 - 734. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Napoli, W. C. Stanley, and L. J. Ignarro Nutrition and cardiovascular disease: Putting a pathogenic framework into focus Cardiovasc Res, January 15, 2007; 73(2): 253 - 256. [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Buse, H. N. Ginsberg, G. L. Bakris, N. G. Clark, F. Costa, R. Eckel, V. Fonseca, H. C. Gerstein, S. Grundy, R. W. Nesto, et al. Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A Scientific Statement From the American Heart Association and the American Diabetes Association Circulation, January 2, 2007; 115(1): 114 - 126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Buse, H. N. Ginsberg, G. L. Bakris, N. G. Clark, F. Costa, R. Eckel, V. Fonseca, H. C. Gerstein, S. Grundy, R. W. Nesto, et al. Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A scientific statement from the American Heart Association and the American Diabetes Association Diabetes Care, January 1, 2007; 30(1): 162 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association Diabetes Care, January 1, 2007; 30(suppl_1): S48 - S65. [Full Text] [PDF]
|
|
|
|
 |
|
 J. O. Hill Understanding and Addressing the Epidemic of Obesity: An Energy Balance Perspective Endocr. Rev., December 1, 2006; 27(7): 750 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Morens, V. Sirot, A. J. W. Scheurink, and G. van Dijk Low-carbohydrate diets affect energy balance and fuel homeostasis differentially in lean and obese rats Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2006; 291(6): R1622 - R1629. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Uribarri and K. R. Tuttle Advanced Glycation End Products and Nephrotoxicity of High-Protein Diets Clin. J. Am. Soc. Nephrol., November 1, 2006; 1(6): 1293 - 1299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. McLaughlin, S. Carter, C. Lamendola, F. Abbasi, G. Yee, P. Schaaf, M. Basina, and G. Reaven Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Am. J. Clinical Nutrition, October 1, 2006; 84(4): 813 - 821. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Nutrition Recommendations and Interventions for Diabetes-2006: A position statement of the American Diabetes Association. Diabetes Care, September 1, 2006; 29(9): 2140 - 2157. [Full Text] [PDF]
|
|
|
|
|
|
I. G.E. Zarraga and E. R. Schwarz Impact of Dietary Patterns and Interventions on Cardiovascular Health Circulation, August 29, 2006; 114(9): 961 - 973. [Full Text] [PDF]
|
|
|
|
 |
|
 K. McAuley and J. Mann Thematic review series: Patient-Oriented Research. Nutritional determinants of insulin resistance J. Lipid Res., August 1, 2006; 47(8): 1668 - 1676. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Lichtenstein Thematic review series: Patient-Oriented Research. Dietary fat, carbohydrate, and protein: effects on plasma lipoprotein patterns J. Lipid Res., August 1, 2006; 47(8): 1661 - 1667. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. McMillan-Price, P. Petocz, F. Atkinson, K. O'Neill, S. Samman, K. Steinbeck, I. Caterson, and J. Brand-Miller Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial. Arch Intern Med, July 24, 2006; 166(14): 1466 - 1475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J Moran, M. Noakes, P. M Clifton, G. A Wittert, G. Williams, and R. J Norman Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome Am. J. Clinical Nutrition, July 1, 2006; 84(1): 77 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M Krauss, P. J Blanche, R. S Rawlings, H. S Fernstrom, and P. T Williams Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia Am. J. Clinical Nutrition, May 1, 2006; 83(5): 1025 - 1031. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S Johnston, S. L Tjonn, P. D Swan, A. White, H. Hutchins, and B. Sears Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets Am. J. Clinical Nutrition, May 1, 2006; 83(5): 1055 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L A Adams and P Angulo Treatment of non-alcoholic fatty liver disease. Postgrad. Med. J., May 1, 2006; 82(967): 315 - 322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Ma, Y. Li, D. E. Chiriboga, B. C. Olendzki, J. R. Hebert, W. Li, K. Leung, A. R. Hafner, and I. S. Ockene Association between Carbohydrate Intake and Serum Lipids. J. Am. Coll. Nutr., April 1, 2006; 25(2): 155 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E Laredo Obesity, polycystic ovary syndrome, infertility treatment: Asking obese women to lose weight before treatment increases stigmatisation BMJ, March 11, 2006; 332(7541): 609 - 609. [Full Text]
|
|
|
|
 |
|
 E. T. Beckley Low-Fat or Low-Carb for Weight Loss? DOC News, March 1, 2006; 3(3): 1 - 21. [Full Text]
|
|
|
|
|
|
A. J. Nordmann, A. Nordmann, M. Briel, U. Keller, W. S. Yancy Jr, B. J. Brehm, and H. C. Bucher Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors: A Meta-analysis of Randomized Controlled Trials. Arch Intern Med, February 13, 2006; 166(3): 285 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Strychar Diet in the management of weight loss Can. Med. Assoc. J., January 3, 2006; 174(1): 56 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Grundy, J. I. Cleeman, S. R. Daniels, K. A. Donato, R. H. Eckel, B. A. Franklin, D. J. Gordon, R. M. Krauss, P. J. Savage, S. C. Smith Jr, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement Circulation, October 25, 2005; 112(17): 2735 - 2752. [Full Text] [PDF]
|
|
|
|
 |
|
 D A van Heel, J Dart, S Nichols, D P Jewell, and R J Playford Novel presentation of coeliac disease after following the Atkins' low carbohydrate diet Gut, September 1, 2005; 54(9): 1342 - 1342. [Full Text] [PDF]
|
|
|
|
|
|
S. Klaus Increasing the Protein:Carbohydrate Ratio in a High-Fat Diet Delays the Development of Adiposity and Improves Glucose Homeostasis in Mice J. Nutr., August 1, 2005; 135(8): 1854 - 1858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. L Blackburn and W A. Walker Science-based solutions to obesity: what are the roles of academia, government, industry, and health care? Am. J. Clinical Nutrition, July 1, 2005; 82(1): 207S - 210S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. B Hu Protein, body weight, and cardiovascular health Am. J. Clinical Nutrition, July 1, 2005; 82(1): 242S - 247S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The American Diabetes Association, the North American Association for the Study of Ob, and and the American Society for Clinical Nutrition Weight Management Using Lifestyle Modification in the Prevention and Management of Type 2 Diabetes: Rationale and Strategies Clin. Diabetes, July 1, 2005; 23(3): 130 - 136. [Full Text] [PDF]
|
|
|
|
|
|
J. O Hill Obesity treatment: does one size fit all? Am. J. Clinical Nutrition, June 1, 2005; 81(6): 1253 - 1254. [Full Text] [PDF]
|
|
|
|
|
|
J. S. Volek, M. J. Sharman, and C. E. Forsythe Modification of Lipoproteins by Very Low-Carbohydrate Diets J. Nutr., June 1, 2005; 135(6): 1339 - 1342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Moreyra, A. C. Wilson, and A. Koraym Effect of Combining Psyllium Fiber With Simvastatin in Lowering Cholesterol Arch Intern Med, May 23, 2005; 165(10): 1161 - 1166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Parikh, M. C. McDaniel, M. D. Ashen, J. I. Miller, M. Sorrentino, V. Chan, R. S. Blumenthal, and L. S. Sperling Diets and Cardiovascular Disease: An Evidence-Based Assessment J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1379 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
|
Article
