Abstract
Background:
Low-carbohydrate diets are popular for weight loss, but their cardiovascular effects have not been well-studied, particularly in diverse populations.
Objective:
To examine the effects of a low-carbohydrate diet compared with a low-fat diet on body weight and cardiovascular risk factors.
Design:
A randomized, parallel-group trial. (ClinicalTrials.gov: NCT00609271)
Setting:
A large academic medical center.
Participants:
148 men and women without clinical cardiovascular disease and diabetes.
Intervention:
A low-carbohydrate (<40 g/d) or low-fat (<30% of daily energy intake from total fat [<7% saturated fat]) diet. Both groups received dietary counseling at regular intervals throughout the trial.
Measurements:
Data on weight, cardiovascular risk factors, and dietary composition were collected at 0, 3, 6, and 12 months.
Results:
Sixty participants (82%) in the low-fat group and 59 (79%) in the low-carbohydrate group completed the intervention. At 12 months, participants on the low-carbohydrate diet had greater decreases in weight (mean difference in change, −3.5 kg [95% CI, −5.6 to −1.4 kg]; P = 0.002), fat mass (mean difference in change, −1.5% [CI, −2.6% to −0.4%]; P = 0.011), ratio of total–high-density lipoprotein (HDL) cholesterol (mean difference in change, −0.44 [CI, −0.71 to −0.16]; P = 0.002), and triglyceride level (mean difference in change, −0.16 mmol/L [−14.1 mg/dL] [CI, −0.31 to −0.01 mmol/L {−27.4 to −0.8 mg/dL}]; P = 0.038) and greater increases in HDL cholesterol level (mean difference in change, 0.18 mmol/L [7.0 mg/dL] [CI, 0.08 to 0.28 mmol/L {3.0 to 11.0 mg/dL}]; P < 0.001) than those on the low-fat diet.
Limitation:
Lack of clinical cardiovascular disease end points.
Conclusion:
The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.
Primary Funding Source:
National Institutes of Health.
References
- 1.
Go AS ,Mozaffarian D ,Roger VL ,Benjamin EJ ,Berry JD ,Borden WB ,et al ;American Heart Association Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6-e245. [PMID: 23239837] doi:10.1161/CIR.0b013e31828124ad CrossrefMedlineGoogle Scholar - 2.
Halton TL ,Willett WC ,Liu S ,Manson JE ,Albert CM ,Rexrode K ,et al . Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002. [PMID: 17093250] CrossrefMedlineGoogle Scholar - 3.
Lagiou P ,Sandin S ,Lof M ,Trichopoulos D ,Adami HO ,Weiderpass E . Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ. 2012;344:e4026. [PMID: 22735105] doi:10.1136/bmj.e4026 CrossrefMedlineGoogle Scholar - 4.
Stern L ,Iqbal N ,Seshadri P ,Chicano KL ,Daily DA ,McGrory J ,et al . The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778-85. [PMID: 15148064] LinkGoogle Scholar - 5.
Davis NJ ,Tomuta N ,Schechter C ,Isasi CR ,Segal-Isaacson CJ ,Stein D ,et al . 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. Diabetes Care. 2009;32:1147-52. [PMID: 19366978] doi:10.2337/dc08-2108 CrossrefMedlineGoogle Scholar - 6.
Sacks FM ,Bray GA ,Carey VJ ,Smith SR ,Ryan DH ,Anton SD ,et al . Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-73. [PMID: 19246357] doi:10.1056/NEJMoa0804748 CrossrefMedlineGoogle Scholar - 7.
Krauss RM ,Eckel RH ,Howard B ,Appel LJ ,Daniels SR ,Deckelbaum RJ ,et al . AHA Dietary Guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-99. [PMID: 11056107] CrossrefMedlineGoogle Scholar - 8.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) . Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421. [PMID: 12485966] CrossrefMedlineGoogle Scholar - 9.
Stone NJ ,VanHorn L . Therapeutic lifestyle change and Adult Treatment Panel III: evidence then and now. Curr Atheroscler Rep. 2002;4:433-43. [PMID: 12361490] CrossrefMedlineGoogle Scholar - 10.
Nutrition Data System for Research . The Minnesota Nutrition Data System. Minneapolis, MN: Univ of Minnesota; 2005. Google Scholar - 11.
Pickering TG ,Hall JE ,Appel LJ ,Falkner BE ,Graves J ,Hill MN ,et al ;Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research . Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45:142-61. [PMID: 15611362] MedlineGoogle Scholar - 12.
Allain CC ,Poon LS ,Chan CS ,Richmond W ,Fu PC . Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20:470-5. [PMID: 4818200] CrossrefMedlineGoogle Scholar - 13.
Friedewald WT ,Levy RI ,Fredrickson DS . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499-502. [PMID: 4337382] CrossrefMedlineGoogle Scholar - 14.
Samaha FF ,Iqbal N ,Seshadri P ,Chicano KL ,Daily DA ,McGrory J ,et al . A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348:2074-81. [PMID: 12761364] CrossrefMedlineGoogle Scholar - 15.
Brehm BJ ,Seeley RJ ,Daniels SR ,D'Alessio DA . A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003;88:1617-23. [PMID: 12679447] CrossrefMedlineGoogle Scholar - 16.
Seshadri P ,Iqbal N ,Stern L ,Williams M ,Chicano KL ,Daily DA ,et al . A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. Am J Med. 2004;117:398-405. [PMID: 15380496] CrossrefMedlineGoogle Scholar - 17.
Wilson PW ,D'Agostino RB ,Levy D ,Belanger AM ,Silbershatz H ,Kannel WB . Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837-47. [PMID: 9603539] CrossrefMedlineGoogle Scholar - 18.
Molenberghs G ,Kenward M . Missing Data in Clinical Studies. Hoboken, NJ: J Wiley; 2007. Google Scholar - 19.
Brinkworth GD ,Noakes M ,Buckley JD ,Keogh JB ,Clifton PM . Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr. 2009;90:23-32. [PMID: 19439458] doi:10.3945/ajcn.2008.27326 CrossrefMedlineGoogle Scholar - 20.
Dansinger ML ,Gleason JA ,Griffith JL ,Selker HP ,Schaefer EJ . Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53. [PMID: 15632335] CrossrefMedlineGoogle Scholar - 21.
Foster GD ,Wyatt HR ,Hill JO ,Makris AP ,Rosenbaum DL ,Brill C ,et al . Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010;153:147-57. [PMID: 20679559] doi:10.7326/0003-4819-153-3-201008030-00005 LinkGoogle Scholar - 22.
Foster GD ,Wyatt HR ,Hill JO ,McGuckin BG ,Brill C ,Mohammed BS ,et al . A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082-90. [PMID: 12761365] CrossrefMedlineGoogle Scholar - 23.
Shai I ,Schwarzfuchs D ,Henkin Y ,Shahar DR ,Witkow S ,Greenberg I ,et al ;Dietary Intervention Randomized Controlled Trial (DIRECT) Group . Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-41. [PMID: 18635428] doi:10.1056/NEJMoa0708681 CrossrefMedlineGoogle Scholar - 24.
Gardner CD ,Kiazand A ,Alhassan S ,Kim S ,Stafford RS ,Balise RR ,et al . 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. 2007;297:969-77. [PMID: 17341711] CrossrefMedlineGoogle Scholar - 25.
Hu T ,Mills KT ,Yao L ,Demanelis K ,Eloustaz M ,Yancy WS ,et al . Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. 2012;176 Suppl 7:S44-54. [PMID: 23035144] doi:10.1093/aje/kws264 CrossrefMedlineGoogle Scholar - 26.
Ebbeling CB ,Swain JF ,Feldman HA ,Wong WW ,Hachey DL ,Garcia-Lago E ,et al . Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012;307:2627-34. [PMID: 22735432] doi:10.1001/jama.2012.6607 CrossrefMedlineGoogle Scholar - 27.
Gardner CD ,Fortmann SP ,Krauss RM . Association of small low-density lipoprotein particles with the incidence of coronary artery disease in men and women. JAMA. 1996;276:875-81. [PMID: 8782636] CrossrefMedlineGoogle Scholar - 28.
Ross R . Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340:115-26. [PMID: 9887164] CrossrefMedlineGoogle Scholar - 29.
Cardillo S ,Seshadri P ,Iqbal N . The effects of a low-carbohydrate versus low-fat diet on adipocytokines in severely obese adults: three-year follow-up of a randomized trial. Eur Rev Med Pharmacol Sci. 2006;10:99-106. [PMID: 16875041] MedlineGoogle Scholar - 30.
U.S. Preventive Services Task Force . Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396-404. [PMID: 19293072] LinkGoogle Scholar - 31.
Larosa JC ,Fry AG ,Muesing R ,Rosing DR . Effects of high-protein, low-carbohydrate dieting on plasma lipoproteins and body weight. J Am Diet Assoc. 1980;77:264-70. [PMID: 7410754] MedlineGoogle Scholar
Author, Article, and Disclosure Information
Lydia A. Bazzano,
From Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Kaiser Permanente Southern California, Pasadena, California; and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Acknowledgment: The authors thank the study participants for their cooperation.
Grant Support: From the National Center for Research Resources of the National Institutes of Health (NIH/NCRR P20-RR017659) to the Tulane University Hypertension and Renal Center of Excellence.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0180.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Bazzano (e-mail, lbazzano@tulane.
Corresponding Author: Lydia Bazzano, MD, PhD, MPH, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, SL-18, Suite 2000, New Orleans, LA 70112; e-mail, lbazzano@tulane.
Current Author Ad dresses: Drs. Bazzano, Hu, Yao, Whelton, and He; Ms. Bunol; Ms. Liu; and Ms. Chen: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, SL-18, Suite 2000, New Orleans, LA 70112.
Dr. Reynolds: Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA 91101.
Dr. Klag: Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room W1041, Baltimore, MD 21205.
Author Contributions: Conception and design: L.A. Bazzano, T. Hu, K. Reynolds, L. Yao, M.J. Klag, J. He.
Analysis and interpretation of the data: L.A. Bazzano, T. Hu, Y. Liu, C.S. Chen, M.J. Klag, P.K. Whelton, J. He.
Drafting of the article: L.A. Bazzano, T. Hu.
Critical revision of the article for important intellectual content: L.A. Bazzano, T. Hu, K. Reynolds, L. Yao, P.K. Whelton, J. He.
Final approval of the article: L.A. Bazzano, K. Reynolds, M.J. Klag, P.K. Whelton, J. He.
Provision of study materials or patients: L.A. Bazzano, C. Bunol.
Statistical expertise: T. Hu, C.S. Chen.
Obtaining of funding: L.A. Bazzano.
Administrative, technical, or logistic support: L.A. Bazzano, L. Yao, C. Bunol.
Collection and assembly of data: L.A. Bazzano, L. Yao, C.S. Chen, J. He.
* Drs. Bazzano and Hu contributed equally to this work.
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
*All comments submitted after October 1, 2021 and selected for publication will be published online only.