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A low-carbohydrate as compared with a low-fat diet in severe obesity
Journal article   Open access   Peer reviewed

A low-carbohydrate as compared with a low-fat diet in severe obesity

Frederick F Samaha, Nayyar Iqbal, Prakash Seshadri, Kathryn L Chicano, Denise A Daily, Joyce McGrory, Terrence Williams, Monica Williams, Edward J Gracely and Linda Stern
The New England journal of medicine, v 348(21), pp 2074-2081
22 May 2003
DOI: https://doi.org/10.1056/NEJMoa022637
PMID: 12761364
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1056/nejmoa022637View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open
url
https://doi.org/10.1056/NEJMoa022637View
Published, Version of Record (VoR) Open

Abstract

Body Mass Index Diabetes Mellitus - blood Diabetes Mellitus - diet therapy Dietary Carbohydrates - administration & dosage Obesity - diet therapy Humans Middle Aged Risk Factors Insulin Resistance Male Obesity - blood Metabolic Syndrome - blood Weight Loss Arteriosclerosis Diet, Fat-Restricted Lipids - blood Diet, Reducing - methods Triglycerides - blood Metabolic Syndrome - diet therapy Female Blood Glucose - metabolism
The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed. We randomly assigned 132 severely obese subjects (including 77 blacks and 23 women) with a mean body-mass index of 43 and a high prevalence of diabetes (39 percent) or the metabolic syndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate) diet or a calorie- and fat-restricted (low-fat) diet. Seventy-nine subjects completed the six-month study. An analysis including all subjects, with the last observation carried forward for those who dropped out, showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet (mean [+/-SD], -5.8+/-8.6 kg vs. -1.9+/-4.2 kg; P=0.002) and had greater decreases in triglyceride levels (mean, -20+/-43 percent vs. -4+/-31 percent; P=0.001), irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications. Insulin sensitivity, measured only in subjects without diabetes, also improved more among subjects on the low-carbohydrate diet (6+/-9 percent vs. -3+/-8 percent, P=0.01). The amount of weight lost (P<0.001) and assignment to the low-carbohydrate diet (P=0.01) were independent predictors of improvement in triglyceride levels and insulin sensitivity. 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 fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost. This finding should be interpreted with caution, given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study. Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.

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903 citations in Web of Science
1124 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Medicine, General & Internal
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