Obesity / Weight Loss

Pre-operative Very Low Calorie Ketogenic Diet (VLCKD) vs. Very Low Calorie Diet (VLCD): Surgical Impact

Alice Albanese, L. Prevedello, M. Markovich, L. Busetto, R. Vettor, M. Foletto

Pre-operative diet may play an important role as far as patients’ fitness for surgery, post-operative outcomes, and successful weight loss.  Our aim was to compare surgical outcome and weight loss in two groups of patients who were offered two different pre-operative kinds of diet: very low calorie diet (VLCD) and very low calorie ketogenic diet (VLCKD).

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Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome

Robert H. Lustig; Kathleen Mulligan; Susan M. Noworolsk;i Viva W. Tai; Michael J. Wen; Ayca Erkin‐Cakmak; Alejandro Gugliucci; Jean‐Marc Schwarz

Single arm prospective with 27 participants from 2 specific, at risk, ethnic groups:  This study argues that the health detriments of sugar, and fructose specifically, are independent of its caloric value or effects on weight. Further studies will be required to determine whether sugar restriction alone can impact metabolic syndrome in adults and whether such effects are short‐lived or long‐term.

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Effect of 6-month Adherence to a Very Low Carbohydrate Diet Program

Eric C Westman, MD, MHS; William S Yancy, MD; Joel S Edman, DSc; Keith F Tomlin; Christine E Perkins, MSW

Single arm prospective with 51 participants:  In these subjects, the mean body weight decreased 10.3% +/- 5.9% from baseline to 6 months. The mean percentage of body weight that was fat decreased 2.9% +/- 3.2% from baseline to 6 months. Serum total cholesterol level decreased 11 +/- 26 mg/dL, low-density lipoprotein cholesterol level decreased 10 +/- 25 mg/dL, triglyceride level decreased 56 +/- 45 mg/dL, high-density lipoprotein (HDL) cholesterol level increased 10 +/- 8 mg/dL, and the cholesterol/HDL cholesterol ratio decreased 0.9 +/- 0.6 units. A very low carbohydrate diet program led to sustained weight loss during a 6-month period.

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Body Composition and Hormonal Responses to a Carbohydrate-restricted Diet

Jeff S. Volek; Matthew J. Sharman; Dawn M. Love; Neva G. Avery; Ana L. G[oacute]mez; Timothy P. Scheett; William J. Kraemer

Single arm propective with 12 participants:  Authors conclude that a carbohydrate-restricted diet resulted in a significant reduction in fat mass and a concomitant increase in lean body mass in normal-weight men, which may be partially mediated by the reduction in circulating insulin concentrations.

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Effects of a Lowcarbohydrate Diet on Weight Loss and Cardiovascular Risk Factor in Overweight Adolescents

Stephen B. Sondike, MD; Nancy Copperman, MS, RD; Marc S. Jacobson, MD

RCT with 30 participants:  To compare the effects of a low-carbohydrate (LC) diet with those of a low-fat (LF) diet on weight loss and serum lipids in overweight adolescents. The LC group lost more weight (mean, 9.9 +/- 9.3 kg vs 4.1 +/- 4.9 kg) and had improvement in non-HDL cholesterol levels. There were no adverse effects on the lipid profiles of participants in either group. The LC diet appears to be an effective method for short-term weight loss in overweight adolescents and does not harm the lipid profile.

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A Low-carbohydrate as Compared With a Lowfat Diet in Severe Obesity

Frederick F. Samaha, MD; Nayyar Iqbal, MD; Prakash Seshadri, MD; Kathryn L. Chicano, CRNP; Denise A. Daily, RD; Joyce McGrory, CRNP; Terrence Williams, BS; Monica Williams, BS; Edward J. Gracely, PhD; and Linda Stern, MD

RCT with 132 participants:  Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fatrestricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost.

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Effect of a High Saturated Fat and No-starch Diet on Serum Lipid Subfractions in Patients With Documented Atherosclerotic Cardiovascular Disease

James H. Hays, MD; Angela DiSabatino, RN, MS; Robert T. Gorman, PhD; Simi Vincent, PhD, MD; Michael E. Stillabower, MD

Prospective single arm:  To determine whether a diet of high saturated fat and avoidance of starch (HSF-SA) results in weight loss without adverse effects on serum lipids in obese nondiabetic patients.  HSF-SA diet results in weight loss after 6 weeks without adverse effects on serum lipid levels verified by nuclear magnetic resonance, and further weight loss with a lipidneutral effect may persist for up to 52 weeks.

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A Randomized Trial of a Low-Carbohydrate Diet for Obesity

Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD; Brian G. McGuckin, EdM; Carrie Brill, BS; B. Selma Mohammed, MD, PhD; Philippe O. Szapary, MD; Daniel J. Rader, MD; Joel S. Edman, DSc; Samuel Klein, MD

RCT with 63 participants:  The low-carbohydrate diet produced a greater weight loss (4%) than did the conventional diet for the first six months, but the differences were not significant at one year.  The lowcarbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease.

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Effect of Low- Carbohydrate, Unlimited Calorie Diet on the Treatment of Childhood Obesity: A Prospective Controlled Study

James R. BailesJr.; Misty T. Strow; Joseph Werthammer; Richard A. McGinnis; Yoram Elitsur

Non-ramdomized Prospective Controlled Study:  Obese children following a high protein, low CHO diet (<30g/day) lost an average of 5.21 ± 3.44 kg and decreased their BMI by 2.42 ± 1.3 points, compared to the children in the Low Cal Diet (calorie restricted) who gained an average of 2.36 ± 2.54 kg and 1.00 point on the BMI value.  A high protein, low carbohydrate, unlimited calorie diet was superior to a restricted calorie protocol for weight loss in obese school age children; moreover, compliance was better.

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A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia: A Randomized, Controlled Trial

William S. Yancy Jr., MD, MHS; Maren K. Olsen, PhD; John R. Guyton, MD; Ronna P. Bakst, RD; Eric C. Westman, MD, MHS

RCT with 120 participants:  Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet.

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Comparison of Energyrestricted Very Lowcarbohydrate and Low-fat Diets on Weight Loss and Body Composition in Overweight Men and Women

JS Volek; MJ Sharman; AL Gómez; DA Judelson; MR Rubin; G Watson; B Sokmen; R Silvestre; DN French; WJ Kraemer

RCT with 28 particpants:  This study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss, especially in men. A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinically significant but requires further validation.

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Comparison of a Very Low-Carbohydrate and Low-Fat Diet on Fasting Lipids, LDL Subclasses, Insulin Resistance, and Postprandial Lipemic Responses in Overweight Women

Jeff S. Volek , PhD, RD, FACN; Matthew J. Sharman , MA; Ana L. Gómez , MS; Chris DiPasquale , MS; Melissa Roti , PhD; Amy Pumerantz , BS; William J. Kraemer , PhD

Ramdomized crossover with 13 participants:  Compared to a low-fat weight loss diet, a short-term very low-carbohydrate diet did not lower LDL-C but did prevent the decline in HDL-C and resulted in improved insulin sensitivity in overweight and obese, but otherwise healthy women. Small decreases in body mass improved postprandial lipemia, and therefore cardiovascular risk, independent of diet composition.

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Comparison of a Low-fat Diet to a Lowcarbohydrate Diet on Weight Loss, Body Composition, and Risk Factors for Diabetes and Cardiovascular Disease in Free-living, Overweight Men and Women

Kelly A. Meckling; Caitriona O’Sullivan; Dayna Saari

RCT with 31 participants:  Both groups of subjects had significant weight loss over the 10 wk of diet intervention and nearly identical improvements in body weight and fat mass. Only the LC group had a significant decrease in circulating insulin concentrations.  Group results indicated that the diets were equally effective in reducing systolic blood pressure by about 10 mm Hg and diastolic pressure by 5 mm Hg and decreasing plasminogen activator inhibitor-1 bioactivity. These data suggest that energy restriction achieved by a very LC diet is equally effective as a LF diet strategy for weight loss and decreasing body fat in overweight and obese adults.

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Long Term Effects of a Ketogenic Diet in Obese Patients

Hussein M Dashti, MD PhD FICS FACS; Thazhumpal C Mathew, MSc PhD FRCPath; Talib Hussein, MB ChB; Sami K Asfar, MB ChB MD FRCSEd FACS; Abdulla Behbahani, MB ChB FRCS FACSI PhD FICS FACS; Mousa A Khoursheed, MB ChB FRCS FICS; Hilal M Al-Sayer, MD PhD FICS FACS; Yousef Y Bo-Abbas, MD FRCPC; Naji S Al-Zaid, BSc PhD

Single arm prospective with 83 participants:  The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients.  Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol.  Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.

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The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat

Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD, MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP; Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD, DrPH

RCT with 60 participants:  Compared with the NCEP diet, the MLC diet, which is lower in total carbohydrates but higher in complex carbohydrates, protein, and monounsaturated fat, caused significantly greater weight loss over 12 weeks. Weight loss was significantly greater in the Modified Low Carbohydrate (13.6 lb) than in the National Cholesterol Education Program group (7.5 lb), a difference of 6.1 lb. There were significantly favorable changes in all lipid levels within the MLC but not within the NCEP group. Waist-to-hip ratio was significantly decreased within the MLC group.

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Diet-Induced Weight Loss Is Associated with Decreases in Plasma Serum Amyloid A and CReactive Protein Independent of Dietary Macronutrient Composition in Obese Subjects

Kevin D. O’Brien; Bonnie J. Brehm; Randy J. Seeley; Judy Bean; Mark H. Wener; Stephen Daniels; David A. D’Alessio

RCT with 41 participants:  The very low-carbohydrate dieters had a significantly greater decrease in LogSAA, but their weight loss also was significantly greater. In this study, the decreases in inflammatory markers correlated significantly with weight loss. Also, change in LogSAA correlated with change in insulin resistance. Thus, in otherwise healthy, obese women, weight loss was associated with significant decreases in both SAA and CRP. These effects were proportional to the amount of weight lost but independent of dietary macronutrient composition.

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Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction

Michael L. Dansinger, MD; Joi Augustin Gleason, MS, RD; John L. Griffith, PhD; Harry P. Selker, MD, MSPH; Ernst J. Schaefer, MD

RCT with 160 participants:  Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low, although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.

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Urinary Ketones Reflect Serum Ketone Concentration But Do Not Relate to Weight Loss in Overweight Premenopausal Women Following a Lowcarbohydrate/ Highprotein Diet

Mary Dean Coleman, PhD, RD; Sharon M. Nickols-Richardson, PhD, RD

Singel Arm:  Thirteen overweight premenopausal women aged 32 to 45 years consumed <20 g carbohydrate/day with liberal intakes of protein and fat for 2 weeks; thereafter, carbohydrate intake increased 5 g/week for 10 weeks. Serumhydroxybutyrate was correlated with presence of urinary ketones, but no relationship was found between weekly weight change and serum ketone production. Urinary ketones are detected in premenopausal women complying with a low-carbohydrate/high-protein diet and are associated with serum ketone concentration.

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Effect of a Low- Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes

Guenther Boden, MD; Karin Sargrad, MS, RD, CDE; Carol Homko, PhD, RN, CDE; Maria Mozzoli, BS; T. Peter Stein, PhD

Single arm – meabolic ward with 10 participants:  In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels.

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Short-Term Effects of Severe Dietary Carbohydrate-Restriction Advice in Type 2 Diabetes – a Randomized Controlled Trial

M. E. Daly; R. Paisey; B. A. Millward; C. Eccles; K. Williams; S. Hammersley; K. M. MacLeod; T. J. Gale

RCT with 102 participants:  Weight loss and high-density lipoprotein (HDL) ratio improved was greater in the low-carbohydrate (LC) group over low fat group. Carbohydrate restriction was an effective method of achieving short-term weight loss compared with standard advice.

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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

Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD

RCT with 311 participants:  In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets.

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