Comparison of Weight- Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates

Frank M. Sacks, MD; George A. Bray, MD; Vincent J. Carey, PhD; Steven R. Smith, MD; Donna H. Ryan, MD; Stephen D. Anton, PhD; Katherine McManus, MS, RD; Catherine M. Champagne, PhD; Louise M. Bishop, MS, RD; Nancy Laranjo, BA; Meryl S. Leboff, MD; Jennifer C. Rood, PhD; Lilian de Jonge, PhD; Frank L. Greenway, MD; Catherine M. Loria, PhD; Eva Obarzanek, PhD; Donald A. Williamson, PhD

Randomozed, three arms:  811 overweight adults to one of four diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%.  At end of study, diets higher in protein and fat showed greater weight loss and reduced waist circumference than diet high in carbohdyrates.

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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

Nichola J. Davis, MD, MS; Nora Tomuta, MD; Clyde Schechter, MD; Carmen R. Isasi, MD, PHD; C.J. Segal-Isaacson, EDD, RD; Daniel Stein, MD; Joel Zonszein, MD; Judith Wylie-Rosett, EDD, RD

RCT with 105 participants:  Among patients with type 2 diabetes, after 1 year a lowcarbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group in the first 3 months.

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Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months

Grant D Brinkworth; Manny Noakes; Jonathan D Buckley; Jennifer B Keogh; Peter M Clifton

RCT with 69 participants:  Low Carb group (over a isocaloric low fat diet) had greater decreases in triglycerides, increases in HDL cholesterol, and LDL cholesterol, and a greater but nonsignificant increase in apolipoprotein B. Both dietary patterns resulted in similar weight loss and changes in body composition. The LC diet may offer clinical benefits to obese persons with insulin resistance.

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A randomized trial of a low-carbohydrate diet vs orlistat plus a low-fat diet for weight loss.

William S. Yancy Jr, MD, MHS; Eric C. Westman, MD, MHS; Jennifer R. McDuffie, PhD, RD, MPH; Steven C. Grambow, PhD; Amy S. Jeffreys, MStat; Jamiyla Bolton, MS; Allison Chalecki, RD; Eugene Z. Oddone, MD, MHS

RCT with 146 participants:  Obese and overweight outpatients were assigned to either a low-carbohydrate ketogenic diet (LCKD) or Orlistat therapy combined with a low fat diet (O + LFD). In a sample of medical outpatients, an LCKD led to similar improvements as O + LFD for weight, serum lipid, and glycemic parameters and was more effective for lowering blood pressure.

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Limited Effect of Dietary Saturated Fat on Plasma Saturated Fat in the Context of a Low Carbohydrate Diet

Cassandra E. ForsytheStephen; D. Phinney; Richard D. Feinman; Brittanie M. Volk; Daniel Freidenreich; Erin QuannKevin Ballard; Michael J. Puglisi; Carl M. Maresh; William J. Kraemer; Douglas M. Bibus; Maria Luz Fernandez; Jeff S. Volek

Randomized crossover with 8 participants:  Authors showed that a hypocaloric carbohydrate restricted diet (CRD) had two striking effects: (1) a reduction in plasma saturated fatty acids (SFA) despite higher intake than a low fat diet, and (2) a decrease in inflammation despite a significant increase in arachidonic acid (ARA). These findings are consistent with the concept that dietary saturated fat is efficiently metabolize in the presence of low carbohydrate, and that a CRD results in better preservation of plasma ARA.

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Changes in Body Weight and Metabolic Indexes in Overweight Breast Cancer Survivors Enrolled in a Randomized Trial of Low-Fat vs. Reduced Carbohydrate Diets

Cynthia A. Thomson; Alison T. Stopeck; Jennifer W. Bea; Ellen Cussler; Emily Nardi; Georgette Frey; Patricia A. Thompson

RCT with 40 Participants:  A group of overweight female breast cancer survivors were assigned either a low-fat diet or Modified Atkins Diet. All subjects demonstrated improvements in total/HDL cholesterol ratio, and significant reductions inHbA1c, insulin, and HOMA. Triglycerides levels were significantly reduced only in the low-carbohydrate diet group. Significant improvements in weight and metabolic indexes can be demonstrated among overweight breast cancer survivors adherent to either the Modified Atkins Diet or fatrestricted diet.

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Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents

Nancy F. Krebs, MD, MS; Dexiang Gao, PhD; Jane Gralla, PhD; Juliet S. Collins; MD, Susan L. Johnson, PhD

RCT with 46 participants:  Significant reduction in BMI-Z-score was achieved in both groups during intervention, and was significantly greater for the HPLC (high protein low carbohydrate) group.  Both groups maintained significant BMI-Z reduction at follow-up; changes were not significantly different between groups.  The HPLC diet is a safe and effective option for medically supervised weight loss in severely obese adolescents.

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Effects of a Low-intensity Intervention That Prescribed a Low Carbohydrate vs. a Low Fat Diet in Obese, Diabetic Participants

Nayyar Iqbal; Marion L. Vetter; Reneé H. Moore; Jesse L. Chittams; Cornelia V. Dalton‐Bakes; Monique Dowd; Catherine Williams‐Smith; Serena Cardillo; Thomas A. Wadden

RCT with 104 Participants:  At this time, participants in the low-carbohydrate group lost 1.5 kg, compared to 0.2 kg in the low-fat group (P = 0.147). Lipids, glycemic indexes, and dietary intake did not differ between groups at month 24 (or at months 6 or 12).

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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; Samuel Klein, MD

RCT with 307 participants:  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. Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. 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 low carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.

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Effects of a moderate low-carbohydrate diet on preferential abdominal fat loss and cardiovascular risk factors in patients with type 2 diabetes

Tae Sasakabe, Hajime Haimoto, Hiroyuki Umegaki, Kenji Wakai

Single arm prospective with 52 participants:  Six months of a moderate LCD resulted in preferential VAT (visceral adipose tissue) loss only in women, with significant correlations between % change SAT (subcutaneous adipose tissue) and both change HDL and change FBG (fasting blood glucose), as well as between % change VAT and change TG.  Authors results suggest that an LCD has the potential to reduce abdominal fat in patients with T2DM and deterioration of serum lipid profiles.

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Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes

Talib A. Hussain, M.B., Ch.B., R.C.G.P.; Thazhumpal C. Mathew, M.Sc., Ph.D., F.R.C.Path.; Ali A. Dashti, M.Sc., Ph.D.; Sami Asfar, M.B., Ch.B., M.D., F.R.C.S., F.A.C.S.; Naji Al-Zaid, B.Sc., Ph.D.; Hussein M. Dashti, M.D., Ph.D., F.I.C.S., F.A.C.S.

Non-randomized 2 arm prospective with 363 participants:  This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects.  The ketogenic diet appears to improve glycemic control.  Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.

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Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney

Allon N. Friedman, Lorraine G. Ogden, Gary D. Foster, Samuel Klein, Richard Stein, Bernard Miller, James O. Hill, Carrie Brill, Brooke Bailer, Diane R. Rosenbaum, Holly R. Wyatt

RCT with 307 participants:  In healthy obese individuals, a low-carbohydrate highprotein weight-loss diet over 2 years was not associated with noticeably harmful effects on GFR, albuminuria, or fluid and electrolyte balance compared with a low-fat diet.

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Renal Function Following Three Distinct Weight Loss Dietary Strategies During 2 Years of a Randomized Controlled Trial

RCT – 3 arm with 318 participants:  A low-carbohydrate diet is as safe as Mediterranean or low fat diets in preserving/improving renal function among moderately obese participants with or without type 2 diabetes, with baseline serum creatinine <176 μmol/L. Potential improvement is likely to be mediated by weight loss-induced improvements in insulin sensitivity and blood pressure.

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Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects

Megan R. Ruth, Ava M. Port, Mitali Shah, Ashley C. Bourland, Nawfal W. Istfan, Kerrie P. Nelson, Noyan Gokce, Caroline M. Apovian

RCT with 55 participants:  Relative to the Low Fat/High Carb group, the High Fat/Low Carb group had greater improvements in blood lipids and systemic inflammation with similar changes in body weight and composition. This small-scale study suggests that HFLC diets may be more beneficial to cardiovascular health and inflammation in free-living obese adults compared to LFHC diets.

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Long Term Successful Weight Loss with a Combination Biphasic Ketogenic Mediterranean Diet and Mediterranean Diet Maintenance Protocol

Antonio Paoli, Antonino Bianco, Keith A Grimaldi, Alessandra Lodi, Gerardo Bosco

Single arm perspective with 89 participants:  The data from this study demonstrate that the majority of subjects showed significant weight loss (10%) as a result of a two-phase VLCKD and were compliant both during the six month weight loss phase and the six month normocaloric maintenance phase, with no weight regain. We can suggest that the proposed protocol was generally successful because of (a) the protein mass protective effects of a VLCKD and (b) the prescription of a traditional Mediterranean diet in the post weight-loss phase was especially important for achieving “weight loss success”, i.e., continued weight loss for at least one year.

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Dietary carbohydrate restriction improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers in individuals taking statins

Kevin D. Ballarda, Erin E. Quanna, Brian R. Kupchaka, Brittanie M. Volka, Diana M. Kawieckia, Maria Luz Fernandez, Richard L. Seip, Carl M. Maresha, William J. Kraemera, Jeff S.Volek

Single arm perspective with 21 participants.  The results of this study suggest that a CRD could be a sustainable lifestyle that complements statin treatment to improve overall cardio-metabolic risk, particularly for individuals with other risk factors indicative of metabolic syndrome, but future research is needed to determine the effects over a longer period of time.

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