A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity
Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D.
Background The effects of a carbohydrate-restricted diet onweight loss and risk factors for atherosclerosis have been incompletelyassessed.
Methods We randomly assigned 132 severely obese subjects (including77 blacks and 23 women) with a mean body-mass index of 43 anda high prevalence of diabetes (39 percent) or the metabolicsyndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate)diet or a calorie- and fat-restricted (low-fat) diet.
Results Seventy-nine subjects completed the six-month study.An analysis including all subjects, with the last observationcarried forward for those who dropped out, showed that subjectson the low-carbohydrate diet lost more weight than those onthe low-fat diet (mean [±SD], –5.8±8.6 kgvs. –1.9±4.2 kg; P=0.002) and had greater decreasesin triglyceride levels (mean, –20±43 percent vs.–4±31 percent; P=0.001), irrespective of the useor nonuse of hypoglycemic or lipid-lowering medications. Insulinsensitivity, measured only in subjects without diabetes, alsoimproved more among subjects on the low-carbohydrate diet (6±9percent vs. –3±8 percent, P=0.01). The amount ofweight lost (P<0.001) and assignment to the low-carbohydratediet (P=0.01) were independent predictors of improvement intriglyceride levels and insulin sensitivity.
Conclusions Severely obese subjects with a high prevalence ofdiabetes or the metabolic syndrome lost more weight during sixmonths on a carbohydrate-restricted diet than on a calorie-and fat-restricted diet, with a relative improvement in insulinsensitivity and triglyceride levels, even after adjustment forthe amount of weight lost. This finding should be interpretedwith caution, given the small magnitude of overall and between-groupdifferences in weight loss in these markedly obese subjectsand the short duration of the study. Future studies evaluatinglong-term cardiovascular outcomes are needed before a carbohydrate-restricteddiet can be endorsed.
Source Information
From the Philadelphia Veterans Affairs Medical Center (F.F.S., N.I., K.L.C., D.A.D., J.M., T.W., M.W., L.S.); the Department of Medicine, Division of Cardiology (F.F.S.), and the Department of Medicine, Division of Endocrinology (N.I., P.S.), University of Pennsylvania Medical Center; and the Department of Family, Community, and Preventive Medicine, Drexel University College of Medicine (E.J.G.) — all in Philadelphia.
Address reprint requests to Dr. Samaha at Cardiology 8th Fl., MC 111C, University and Woodland Ave., Philadelphia, PA 19104, or at rick.samaha{at}med.va.gov.
Low-Carbohydrate Diets as Compared with Low-Fat Diets
Duggirala M. K., Mundell W. C., Mikkilineni P., Aziz I., Garrido J. A., Roberts C. K., Barnard R. J., Samaha F. F., Stern L., Iqbal N., Foster G. D., Hill J. O., Klein S.
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N Engl J Med 2003;
349:1000-1002, Sep 4, 2003.
Correspondence
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