A randomized controlled trial on the efficacy of carbohydrate-reduced or fat-reduced diets in patients attending a telemedically guided weight loss program

Sabine Frisch, Armin Zittermann, Heiner K Berthold, Christian Götting, Joachim Kuhn, Knut Kleesiek, Peter Stehle, Heinrich Körtke, Sabine Frisch, Armin Zittermann, Heiner K Berthold, Christian Götting, Joachim Kuhn, Knut Kleesiek, Peter Stehle, Heinrich Körtke

Abstract

Background: We investigated whether macronutrient composition of energy-restricted diets influences the efficacy of a telemedically guided weight loss program.

Methods: Two hundred overweight subjects were randomly assigned to a conventional low-fat diet and a low-carbohydrate diet group (target carbohydrate content: >55% energy and <40% energy, respectively). Both groups attended a weekly nutrition education program and dietary counselling by telephone, and had to transfer actual body weight data to our clinic weekly with added Bluetooth technology by mobile phone. Various fatness and fat distribution parameters, energy and macronutrient intake, and various biochemical risk markers were measured at baseline and after 6, and 12 months.

Results: In both groups, energy intake decreased by 400 kcal/d compared to baseline values within the first 6 months and slightly increased again within the second 6 months. Macronutrient composition differed significantly between the groups from the beginning to month 12. At study termination, weight loss was 5.8 kg (SD: 6.1 kg) in the low-carbohydrate group and 4.3 kg (SD: 5.1 kg) in the low-fat group (p = 0.065). In the low-carbohydrate group, triglyceride and HDL-cholesterol levels were lower at month 6 and waist circumference and systolic blood pressure were lower at month 12 compared with the low-fat group (P = 0.005-0.037). Other risk markers improved to a similar extent in both groups.

Conclusion: Despite favourable effects of both diets on weight loss, the carbohydrate-reduced diet was more beneficial with respect to cardiovascular risk factors compared to the fat-reduced diet. Nevertheless, compliance with a weight loss program appears to be even a more important factor for success in prevention and treatment of obesity than the composition of the diet.

Trial registration: Clinicaltrials.gov as NCT00868387.

Figures

Figure 1
Figure 1
Participant flow through the trial.
Figure 2
Figure 2
Weight loss according to weekly telemetric transfer of body weight data during the first 6 study months; results are presented as mean ± standard error of the mean.
Figure 3
Figure 3
Weight loss in patients on an energy-restricted high-carbohydrate diet (DGE group) or an energy-restricted low-carbohydrate diet (LOGI group) at baseline and after 6 and 12 months; results are presented as mean ± standard error of the mean. P = 0.198 between groups at month 6, and P = 0.065 between groups at month 12.

References

    1. Caballero B. The global epidemic of obesity: An overview. Epidemiol Rev. 2007;8:1–5. doi: 10.1093/epirev/mxm012.
    1. World Health Organisation (WHO) Obesity and overweight. September 2006 Fact sheet No. 311. (last accessed 10.09.2008)
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;8:1549–1555. doi: 10.1001/jama.295.13.1549.
    1. Liu S, Manson JE, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE. A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women. Am J Public Health. 2000;8:1409–1415. doi: 10.2105/AJPH.90.9.1409.
    1. Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004;8:774–779.
    1. McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;8:538–546. doi: 10.2337/diacare.27.2.538.
    1. American Heart Association Nutrition Committee. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;8:82–96. doi: 10.1161/CIRCULATIONAHA.106.176158.
    1. World Health Organisation (WHO) Obesity: Preventing and managing the global epidemic. Technical Report Series 894, Geneva. 2000.
    1. Ludwig DS. Novel treatments for obesity. Asia Pac J Clin Nutr. 2003;8(Suppl):S8.
    1. Yancy WS Jr, Westma EC, French PA, Califf RM. Diets and clinical coronary events: the truth is out there. Circulation. 2003;8:10–16. doi: 10.1161/01.CIR.0000049205.35749.00.
    1. Brehm BJ, D'Alessio DA. Weight loss and metabolic benefits with diets of varying fat and carbohydrate content: separating the wheat from the chaff. Nat Clin Pract Endocrinol Metab. 2008;8:140–146. doi: 10.1038/ncpendmet0730.
    1. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;8:2082–2090. doi: 10.1056/NEJMoa022207.
    1. Samaha FF, Iqbal N, Seshardi P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;8:2074–2081. doi: 10.1056/NEJMoa022637.
    1. Stern L, Iqbal N, Seshardi P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomised trial. Ann Intern Med. 2004;8:778–785.
    1. 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;8:1617–1623. doi: 10.1210/jc.2002-021480.
    1. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;8:1563–1571. doi: 10.1056/NEJMoa061883.
    1. Heska S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX. Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA. 2003;8:1792–1798. doi: 10.1001/jama.289.14.1792.
    1. Körtke H, Frisch S, Zittermann A, Berthold HK, El-Arousy M, Götting C, Kleesiek K, Stehle P, Körfer R. [A telemetrically-guided program for weight reduction in overweight subjects (the SMART study)] Dtsch Med Wochenschr. 2008;8:1297–1303. doi: 10.1055/s-2008-1077256.
    1. Worm N. Glücklich und Schlank. Mit viel Eiweiß und dem richtigen Fett. Die LOGI-Methode in Theorie und Küche. Lünen: systemed Verlag; 2003.
    1. Stehle P. Dissemination of nutritional knowledge in Germany – nutrition circle, 3D food pyramid and 10 nutrition guidelines. Ann Nutr Metab. 2007;8(suppl 2):21–25. doi: 10.1159/000103563.
    1. Ebbeling CB, Leidig MM, Sinclair KB, Seger-Shippee LG, Feldman HA, Ludwig DS. Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults. Am J Clin Nutr. 2005;8:976–982.
    1. Dohmen B, Luttermann-Semmer E, Oberritter H, Rademacher C. ICH nehme ab. Ein Dauerprogramm zum Abnehmen und Wohlfühlen. Deutsche Gesellschaft für Ernährung e.V. Meckenheim: DCM; 2005.
    1. Mangiameli F, Worm N. LOGI GUIDE. Tabellen mit über 500 Lebensmitteln, bewertet nach ihrem glykämischen Index und ihrer glykämischen Last. Lünen: Systemed Verlag; 2004.
    1. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome-a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med. 2006;8:469–480. doi: 10.1111/j.1464-5491.2006.01858.x.
    1. Volkert D, Kreuel K, Heseker H, Stehle P. Energy and nutrient intake of young-old, old-old, and very-old elderly in Germany. Eur J Clin Nutr. 2004;8:1190–1200. doi: 10.1038/sj.ejcn.1601950.
    1. Frey I, Berg A, Grathwohl D, Keul J. [Freiburg Questionnaire of physical activity development, evaluation and application] Soz Praventivmed. 1999;8:55–64. doi: 10.1007/BF01667127. [in German]
    1. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;8:71–80. doi: 10.1249/00005768-199301000-00011.
    1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;8(Suppl):S498–504. doi: 10.1097/00005768-200009001-00009.
    1. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. 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;8:969–977. doi: 10.1001/jama.297.9.969.
    1. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;8(9):859–873. doi: 10.1056/NEJMoa0804748.
    1. Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004;8:769–777.
    1. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ. Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;8:229–241. doi: 10.1056/NEJMoa0708681.
    1. Hatahet W, Cole L, Kudchodkar BJ, Fungwe TV. Dietary fats differentially modulate the expression of lecithin:cholesterol acyltransferase, apoprotein-A1 and scavenger receptor b1 in rats. J Nutr. 2003;8:689–694.
    1. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watcher, and Zone diets for weight loss and heart disease risk reduction. JAMA. 2005;8:43–53. doi: 10.1001/jama.293.1.43.
    1. Festa A, D'Agostino R Jr, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS) Circulation. 2000;8:42–47.
    1. Stühlinger MC, Abbasi F, Chu JW, Lamendola C, McLaughlin TL, Cooke JP, Reaven GM, Tsao PS. Relationship between insulin resistance and an endogenous nitric oxide synthase inhibitor. JAMA. 2002;8:1420–1426. doi: 10.1001/jama.287.11.1420.
    1. Zhu W, Cheng KK, Vanhoutte PM, Lam KS, Xu A. Vascular effects of adiponectin: molecular mechanisms and potential therapeutic intervention. Clin Sci. 2008;8:361–374. doi: 10.1042/CS20070347.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren