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.
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Author, Article and Disclosure Information
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, [email protected]).
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, [email protected].
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.
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