Similar weight Alain Anne-Fran#{231}oise Golay, Gerald Allaz, Yves Morel, Nicolas de Tonnac, Svetalina Tankova, The goal that relative were period persons kcal/d) was 45% assigned composed (7.5 to diets ± 0.5 kg) creases in total body in both groups, and a function of diet carbohydrate. and but neither (8.9 waist-to-hip plasma 0.6 kg) or ± insulin were glucose, that nor deseen did not vary plasma as insulin, decreased contained signifi15% triacylglycerol 1996;63: loss not in response to Am J Clin Nutr 174-8. KEY Obesity, high-carbohydrate weight loss, also received AND a body diet well as attention is little is focused individuals. When grams it is necessary argument that there are widely on how to bring evaluating the to differentiate obesity constitutes different about a opinions weight when loss proof the relation between changes in energy balance and weight loss (5, 6), the ability of individuals to comply with a weight-loss diet (7), and the long-term success of any weight-loss program in preventing a return these issues this instance, been appears to the original consensus argued has that when changes patients containing drate. The tions, and changes 174 were moderate, present study weight reached. lead was high initiated several For in example, obese of of these 30, > with strong psychiatric of a history personal diagnoses, was submitted of the Department to a low-energy multidisciplinary nutritional motivation, were excluded to and accepted of Medicine consisted and diet, subjects program that education, Exercise day by at Geneva and of standard was by tech- exercise physical provided in a physical behavioral 1 h of aerobic 1 h of underwater education participated included training activity per a registered day. dietitian twice a week (once in a group session and once individually). The behavioral approach consisted of six sessions, during which issues of self-control, cognitive restructuring reinforcement, and relapse prevention were addressed. On signed admission to receive consisted I to the hospital, diets containing of either From and 15% patients were randomly 4.2 Mi/d (1000 kcal/d) or 45% of energy as asthat carbohydrate. diets Clinical 2 Address Unit, observa- Geneva patients of the and Nutr the Department University of Medicine, School Center, Geneva of Medicine Department University and Geriatric of Veterans Affairs Hospital, Research, Medical and Education Center, Palo Alto, CA. carbohy- J Clin on the basis Hospital. Stanford carbohydrate Am education. it similar (1200-kcal/d) per loss weight were proportions in 43 of that both to extend facets first but even weight variables 5.0-MJ/d and The to better indicate metabolic a comparison and been et al (12) prescribed low, (8-10). straightforward, diets in associated involved in not low-fat ( 1 1), but data from Alford and weight to be the most were which nutritional decided The protocol committee Nutritional in obese efficacy of weight-loss between considerations it was (kg/rn2) those University niques. (1-4), visit, index the study. activity, there patients during METHODS first mass the ethical INTRODUCTION hazard and lowfrom compliance, of the study, behavioral of of energy and the ability to participate in the requisite amount of physical activity. Patients with obesity secondary to endocrine disease, from low-carbohydrate the structured, Although dietary duration initiation or 45% of failure to lose weight in response to ambulatory treatment that these individuals would benefit if they were hospitalized for the first 6 wk of treatment. Criteria for admission included In addition health the 15% Forty-three adult, obese patients were studied before and after a 6-wk period of hospitalization. These subjects had been referred to the Obesity Outpatient Clinic of the Department of Medicine at Geneva University Hospital for dietary treatment of their obesity. as WORDS diet, weight period. they followed of either To increase for the entire During con- centrations fell significantly in response to the higher-carbohydrate diet. The results of this study showed that it was energy intake, nutrient composition, that determined low-energy diets over a short time carbohydrate. hospitalized SUBJECTS of weight circumference Fasting that consisting carbo- significant of the changes diets time 4.2 metabolism energy and 26% in the amount 15% a obese 15% Furthermore, composition. during 45% carbohydrate, either lipoprotein in containing protein, cholesterol, and triacylglycerol concentrations cantly in patients eating low-energy diets carbohydrate, weight diets 32% difference containing fat different 43 adult, to receive the magnitude the effect widely on body of either no significant in response to evaluate but Consequently, and 53% fat, or 29% protein, fat. There was in energy of fat and carbohydrate randomly (1000 hydrate, low of hospitalization. were MJ/d of this study equally amounts 6-wk loss and 1996;63:174-8. reprint Department requests of to A Golay, Medicine, Diabetes University of Treatment Geneva and Teaching Hospital, 1211, 14, Switzerland. Received November Accepted for publication Printed in USA. 14, 1994. October © 1996 17, American 1995. Society for Clinical Nutrition Downloaded from https://academic.oup.com/ajcn/article/63/2/174/4650505 by guest on 17 February 2023 of diets has 2 Reaven ABSTRACT loss loss with low- or high-carbohydrate WEIGHT Baseline characteristics in Table listed distribution, mass started on tions of the two of rotation diets. 2. Both and A 7-d nutrient (33%), menu (33%), but meals and were present during compliance instructed each with once a week took the quality count. patients the and software PRODI3+ amount less with 5 g). Both diets contained ( ‘ 14 g/d) and cholesterol (22%), a l-d These food Urinary nitrogen used to calculate measured six urine urinary collections. mated on mg/kg body calculated umental (g/d) 60±5 30±5 (%) Protein 53±5 26±5 (gld) 79±9 73±5 (%) 32±5 29±5 SD. ± ‘: by the and record (skinfold used times diet of fat was with 60 ± Kjeldahl with the Integumental basis wt, and of previously respectively reported (21). Daily by subtracting total output losses) from dietary input. measurements at TABLE 1 Physical characteristics biceps, fat method Age(y) subscapula, were 3M, l9F) 41±9 Height (cm) 162 (kg/m2) 41 BP (mm Hg) iE ± SD. BP, blood stool, and 10 was integ- of adiposity were skinfold-thickness and suprailiac ± 9 ± 9 138 ± 14 89 ± 9 pressure. 45% Carbohydrate 6M, (n 1SF) 45±18 107 ± 23 Hg) 5 and 102 ± 164 18 ± 9 38 ± 5 136 ± 18 85 ± 14 = (23). two techniques 0.64, P < as a mean and analyzed of these bioelectrical compo- were signif- 0.0001). two ± SEMs Percent- measurements and procedure analysis approach Body impedance). as means by two-way tiple-comparison were of SAS analyzed (SAS Insti- between the two weight loss, data of variance, of Scheff#{233}(24, with the mul- 25). RESULTS Values for cumferences, in Table total body and 4. These weight, body waist-to-hip ratio values were not fat, waist before the significantly and hip diets are different cirgiven be- tween the two groups at baseline nor was there a significant difference in the amount of weight loss in response to diets containing either fat, 15% waist and or 45% hip significantly the changes percentage weight loss and diet)] [13.9 ± the ratio and the of diet and effect 1 .3 ± 0.5 0.6 g (45%-carbohydrate nitrogen losses of both diets during 1 .8 - during the last S wk. Table 5 lists values for cholesterol, HDL-cholesterol, tions and after ± the though trends diets, was were more significantly equal: nitrogen compared fasting dietary plasma intervention, ± more ± 0.2 (15% than glucose, triacylglycerol were -0.5 was carbohydrate)] significantly contained 15% direction The balance with balance week F- I .5 the first 0.2 g (45% with groups. Nitrogen and decreased which in a similar of The compared between these indexes were not significantly different groups before dieting. These data also show glucose, insulin, cholesterol, HDL-cholesterol, erol concentrations the low-energy not diet) diet) diet). diet loss were diet)] (15%-carbohydrate each and magnitude composition. fat 1.7 g (15%-carbohydrate was before total waist-to-hip percentage 1 1 .2 ± 0.9 g (45%-carbohydrate protein-sparing Furthermore, and than were the absolute changes. intake was similar [12.6 ± 0.3 g compared with 1 1 .7 ± 0.2 g (45%- in carbohydrate groups, as a function vary the two groups Daily dietary nitrogen (1 5%-carbohydrate diet) similar carbohydrate. circumference, in both did not negative with carbohydrate) (kg) (mm esti- balance expressed (r general-linear-models different Weight BP studies: (urine, Carbohydrate (F1 Systolic were linear are expressed the body subjects’ 15% Diastolic losses nitrogen percentage techniques: triceps, of the stool and thickness analysis by these tute mc, Cary, NC). To evaluate the difference groups of obese patients, before and after higher saturated of fat was Data alimen- impedance as assessed correlated age ac- bioelectrical values into 15%-carbohydrate of (22), icantly samples were collected every week loss was computed on the basis of Body fat composition and determined by two different ‘ 45±5 Fat decreased these BMI 115±14 15±5 sition (20). Twenty-four-hour and average daily ± 320 37±5 verify tables (15). was three similar amounts (‘ ‘230 mg/d). was 4296 ± 315 4214 (%) records food consumed in the was To Blood was drawn after a 14-h overnight fast before and after 6 wk of the low-energy diets for measurements of plasma glucose ( 16), plasma immunoreactive insulin ( 17), cholesterol ( 18), high-density-lipoprotein (HDL)-cholesterol, and triacylglycerol concentrations ( 19). Nitrogen balance was measured to compare the protein-sparing effect of the two low-energy diets. (kI/d) Carbohydrate (g/d) The a dietitian 37 ± S g), and the amount diet (30 ± 5 compared 45%-carbohydrate in the than di- (12%). of food was The I d of the (13). Food composition and Renaud and Attil diet (1 15 ± 14 compared and study. of carbohydrate in the 45%-carbohydrate used. compliance. completed the quantity food offered snack foods 6 wk of the tary plans and food records were from Souci et al (14) The absolute all Energy Carbohydrate 45% Carbohydrate two diets were similar. for each patient. All to improve the diet, during The to eat meal Composi- breakfast bedtime of diets’ 15% high-carbohydrate among total energy and protein contents of the Energy intake was carefully measured subjects was from and Composition diets various of low-carbohydrate dinner of composition compositions the menus rotational 2 TABLE patients con- I 75 DIETS insulin, concentraand shows that between the two that fasting plasma and triacylglycin patients carbohydrate. seen when eating Al- patients ate Downloaded from https://academic.oup.com/ajcn/article/63/2/174/4650505 by guest on 17 February 2023 lunch the in Table Recipes are of sex HIGH-CARBOHYDRATE pressure. experimental in Table 3. intake was distributed diets are given Daily energy blood acquired, two similar for and were OR groups shown Itemized menu index, LOW- in terms are standardized. foods. experimental comparable data foods. provided verse WITH of the diets natural were menus one two were metabolic were items body baseline sisted the groups age, After of 1. The LOSS GOLAY 176 TABLE 3 Itemized composition ET AL DISCUSSION of diets Food In this study Weight items varied carbohydrate g 15% Carbohydrate points. Breakfast Low-fat fresh Low-fat ham cheese (20% fat) meat or fish Vegetable closely variations 100 beneficial 180 yogurt meat or eggs 100 Whole-wheat bread 15 Snack 45% fresh cheese (20% fat) effects and fasting plasma of weight lipid Carbohydrate glucose, pasta, 150 50 between 150 60 100 Oil artificially sweetened yogurt be 180 Vegetable Rice, pasta, or cereals Snack Low-fat fresh cheese (20% thermic 150 60 (4%) fat) Fruit less important effect tude of insulin diets the nor response differences containing was triacylglycerol to the TABLE 4 Body composition 45% carbohydrate, attenuated (26). As suggested higher-carbohydrate diet. before loss’ and after weight neither fell been the tendency 1g relevance of this must are ingested, it is theoretically tion in Body effect circumference 99 ± 8.3 issue 104 126±4 on b efore weight and that low in fat intake differences et al. First, variations and prob- in degree For the weight a thermic of ie, a 100-i the of fat it has to fat, other hand, the diets containing 4.2 of carbohydrate is of 50 J associated difference in hypoenergetic loss the diets increasing weight that the that of low-energy of 45% effect that On effect when effect than considerations, of carbohydrate (27). example, thermic to fat on is higher of these the ratio to the unlikely is the evidence (8%) 102 42 that per the day. relative diets ensues with Thus, propor- will have in compliant ± loss: 2 p < 0.001, -‘ P < 0.01, p 1 13 ± 2 ± 3 121 ±2 0.93 0.05. 95 ± 32 7.4 ± 0.6 - 32 < ± 4 41 1.0 117±32 0.88 ± 0.0l ± 0.02 After - ‘ from diets Before 38 ± 22 1 15 ± 4 0.91 different consuming to address ± 0.5 17.7 ± - Hipcircumference(cm) Waist-to-hip ratio i ± SEM. 2--I Significantly ± 5 47 ± 3 (cm) one, reported 45% Carbohydrate After - Fat loss (%) Waist two patients. 107 fat (kg) is a pragmatic of Rabast dependent to gain of carbohydrate significant Before (kg) in in subjects decrease in dietary are two crucial 15% Carbohydrate Total body weight Weight loss (%) fall triacylglycerol, et al (1 1), who weight information be questioned. MJ plasma significantly more a consequence that the higher the less the magni- and concentrations first of carbohydrate 5 1 low-energy The and those 150 J, compared with eating 15% carbohydrate, the the compliance. 100 Oil of carbo- was decreased of Rabast lost are A second meat or eggs cholesterol, and that a simple weight loss. There to and dietary Dinner Low-fat addressed. our results output, Snack Low-fat, measures ably most important, the current studies were performed on inpatients, not outpatients. Second, subjects in our study also participated in programs of physical exercise and both behavioral and nutritional education. Consequently, we believe that the results of our study emphasize issues of energy intake and 100 Fruit insulin, to the other hand, to modify the specifically, concentrations individuals carbohydrate, can lead 5 or cereals More end- in response of the amount of being related most loss on certain metabolism. the publications obese Vegetable Rice, must involves 50 Breakfast Low-fat skimmed milk (0% fat) Whole-wheat bread Butter or margarine Lunch Low-fat meat or fish independent test diets, and metabolic similar to total energy intake (Table 3). On in dietary composition did appear hydrate issues Low-fat various was that fat tions were not statistically significant in these subjects. To put the results of the current study into perspective, 25 Oil and diets of eating a low-energy diet relatively high in carbohydrate, and the changes in plasma insulin and triacylglycerol concentra- 100 Vegetable proportions loss apparently in the two and HDL-cholesterol Low-fat loss of weight was of low-energy relative ± 0.02 34 ± 22 16.8 ± 1.2 103 ± 32 112±22 0.91 ± 0.02 a Downloaded from https://academic.oup.com/ajcn/article/63/2/174/4650505 by guest on 17 February 2023 sweetened Dinner the effects their weight amount 100 Snack artificially on both The the two diets, and fat or carbohydrate Oil Low-fat, in 150 50 Lunch Low-fat we evaluated substantially WEIGHT TABLE LOSS WITH LOW- OR HIGH-CARBOHYDRATE indexes before and after weight loss’ Carbohydrate 15% 45% Carbohydrate Before Plasma Plasma Plasma Plasma glucose (mmolIL) insulin (pmol/L) cholesterol (mmol/L) HDL cholesterol (mmoLfL) Plasma triacylglycerol After 5.3 ± 0.2 106.8 ± 15.6 5.7 (mmolIL) ± 0.3 Significantly conclusion, loss diets from our can weight results occur as inpatients, before and subjects that this ± 0.12 ± 6.62 4.5 ± 0.22 the high-carbohydrate of low-fat, maintenance advocated tion Program insulin and (28) seems triacylglycerol likely insulin related and portion tion, to previous triacylglycerol to dietary the by carbohydrate servation that in weight ate low-energy and carbohydrate diets that are loss 1.8 ± 0.2 p < 0.001, p < advocacy the that dietary by for shown approach. a better this diet, view we are unaware with a weight-loss diet. becomes available, it is energy intake, information to composition, low-energy that diets. suggest We are grateful Medicine to that determines weight in to 13. 14. of assistance, of the dietary especially staff T Lehmann, seems P Rigoli, 16. of C Bussien, persons Alford BB, values Assoc 1990;90:534-40. 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