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Effects of a low-carbohydrate diet on weight loss and cardiometabolic profile in Chinese women: a randomised controlled feeding trial

  • Xin Liu (a1), Geng Zhang (a1), Xingwang Ye (a1), Huaixing Li (a1), Xiafei Chen (a2), Lixin Tang (a2), Ying Feng (a2), Iris Shai (a3), Meir J. Stampfer (a4) (a5), Frank B. Hu (a4) (a5) and Xu Lin (a1)...


Little is known about the potential adherence to and the effectiveness of a low-carbohydrate (LC) diet on weight loss and cardiometabolic risk factors in Chinese adults with a habitually high carbohydrate intake. In the present controlled feeding trial, fifty overweight or obese women (age 47·9 (sem 0·9) years; BMI 26·7 (sem 0·3) kg/m2) were randomly assigned to a LC non-energy-restricted diet (initial carbohydrate intake 20 g/d, with a 10 g increase weekly) or an energy-restricted (ER) diet (carbohydrate intake 156–205 g/d, ER to 5021 or 6276 kJ/d, 35 % average energy reduction) for 12 weeks. Over the intervention period, the two diets had comparable compliance (96 %) and self-reported acceptability. At week 12, carbohydrate intake in the LC and ER groups contributed to 36·1 and 51·1 % of total energy, respectively (P< 0·001). Although both diets showed similarly decreased mean body weight (LC − 5·27 (95 % CI − 6·08, − 4·46) kg; ER − 5·09 (95 % CI − 5·50, − 4·67) kg, P= 0·67) and percentage of fat mass measured by dual-energy X-ray absorptiometry (LC − 1·19 (95 % CI − 1·88, − 0·50) %; ER − 1·56 (95 % CI − 2·20, − 0·92) %, P= 0·42), participants in the LC group had greater reductions in the ratio of total cholesterol:HDL-cholesterol (P= 0·03) and also in the ratio of TAG:HDL-cholesterol (P= 0·01) than those in the ER group. The present 12-week diet trial suggested that both a LC non-energy-restricted diet and an ER diet were acceptable to Chinese women and both diets were equally effective in reducing weight and fat mass. Moreover, the LC diet showed beneficial effects on blood lipid profiles.

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Corresponding author

*Corresponding authors:Dr M. J. Stampfer, fax +1 617 525 2008, email; Dr F. B. Hu, fax +1 617 432 2435, email; Dr X. Lin, fax +86 21 54 920249, email


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1Flegal, KM, Carroll, MD, Ogden, CL, et al. (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303, 235241.
2Berghofer, A, Pischon, T, Reinhold, T, et al. (2008) Obesity prevalence from a European perspective: a systematic review. BMC Public Health 8, 200.
3Hossain, P, Kawar, B & El Nahas, M (2007) Obesity and diabetes in the developing world – a growing challenge. N Engl J Med 356, 213215.
4Wang, Y, Mi, J, Shan, XY, et al. (2007) Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes 31, 177188.
5Chinese Center for Disease Control and Prevention (2011) Major findings in chronic diseases and risk factors of national DSPs in 2010. (accessed accessed September 2011).
6Kelly, T, Yang, W, Chen, CS, et al. (2008) Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 32, 14311437.
7Clifton, PM (2008) Dietary treatment for obesity. Nat Clin Pract Gastroenterol Hepatol 5, 672681.
8Lagiou, P, Sandin, S, Lof, M, et al. (2012) Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ 344, e4026.
9Hession, M, Rolland, C, Kulkarni, U, et al. (2009) Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 10, 3650.
10Santos, FL, Esteves, SS, da Costa Pereira, A, et al. (2012) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 13, 10481066.
11Shai, I, Schwarzfuchs, D, Henkin, Y, et al. (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359, 229241.
12Sacks, FM, Bray, GA, Carey, VJ, et al. (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360, 859873.
13de Souza, RJ, Bray, GA, Carey, VJ, et al. (2012) Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial. Am J Clin Nutr 95, 614625.
14Zhai, F (2005) Report of China Nationwide Nutrition and Health Survey 2002 (2) Diet and Nutrients Intake. Beijing: People Medical Publishing House.
15Villegas, R, Liu, S, Gao, YT, et al. (2007) Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women. Arch Intern Med 167, 23102316.
16Crowe, TC (2005) Safety of low-carbohydrate diets. Obes Rev 6, 235245.
17Sumithran, P & Proietto, J (2008) Ketogenic diets for weight loss: a review of their principles, safety and efficacy. Obes Res Clin Pract 2, 113.
18Pan, A, Sun, J, Chen, Y, et al. (2007) Effects of a flaxseed-derived lignan supplement in type 2 diabetic patients: a randomized, double-blind, cross-over trial. PLoS One 2, e1148.
19Yang, Y (editor) (2005) China Food Composition 2004. Beijing: Peking University Medical Press.
20Pereira, MA, Jacobs, DR Jr, Pins, JJ, et al. (2002) Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr 75, 848855.
21Epstein, LH, Carr, KA, Cavanaugh, MD, et al. (2011) Long-term habituation to food in obese and nonobese women. Am J Clin Nutr 94, 371376.
22Roehrig, M, Thompson, JK & Cafri, G (2008) Effects of dieting-related messages on psychological and weight control variables. Int J Eat Disord 41, 164173.
23Zhai, F, Wang, H, Du, S, et al. (2007) Lifespan nutrition and changing socio-economic conditions in China. Asia Pac J Clin Nutr 16, Suppl. 1, 374382.
24Yoshita, K, Arai, Y, Nozue, M, et al. (2010) Total energy intake and intake of three major nutrients by body mass index in Japan: NIPPON DATA80 and NIPPON DATA90. J Epidemiol 20, Suppl. 3, S515S523.
25Park, SH, Lee, KS & Park, HY (2010) Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III). Int J Cardiol 139, 234240.
26Radhika, G, Van Dam, RM, Sudha, V, et al. (2009) Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology Study 57). Metabolism 58, 675681.
27Hu, EA, Pan, A, Malik, V, et al. (2012) White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 344, e1454.
28Haimoto, H, Iwata, M, Wakai, K, et al. (2008) Long-term effects of a diet loosely restricting carbohydrates on HbA1c levels, BMI and tapering of sulfonylureas in type 2 diabetes: a 2-year follow-up study. Diabetes Res Clin Pract 79, 350356.
29Sasakabe, T, Haimoto, H, Umegaki, H, et al. (2011) Effects of a moderate low-carbohydrate diet on preferential abdominal fat loss and cardiovascular risk factors in patients with type 2 diabetes. Diabetes Metab Syndr Obes 4, 167174.
30Yancy, WS Jr, Foy, M, Chalecki, AM, et al. (2005) A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond) 2, 34.
31Laffel, L (1999) Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev 15, 412426.
32Nickols-Richardson, SM, Coleman, MD, Volpe, JJ, et al. (2005) Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. J Am Diet Assoc 105, 14331437.
33McPherson, PA & McEneny, J (2012) The biochemistry of ketogenesis and its role in weight management, neurological disease and oxidative stress. J Physiol Biochem 68, 141151.
34Westman, EC, Feinman, RD, Mavropoulos, JC, et al. (2007) Low-carbohydrate nutrition and metabolism. Am J Clin Nutr 86, 276284.
35Volek, JS, Fernandez, ML, Feinman, RD, et al. (2008) Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 47, 307318.
36Soenen, S, Bonomi, AG, Lemmens, SG, et al. (2012) Relatively high-protein or ‘low-carb’ energy-restricted diets for body weight loss and body weight maintenance? Physiol Behav 107, 374380.
37Wycherley, TP, Brinkworth, GD, Clifton, PM, et al. (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males. Nutr Diabetes 2, e40.
38Gardner, CD, Kiazand, A, Alhassan, S, et al. (2007) 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 297, 969977.
39Gu, DF, Reynolds, K, Wu, XG, et al. (2005) Prevalence of the metabolic syndrome and overweight among adults in China. Lancet 365, 13981405.
40Ervin RB and National Center for Health Statistics (US) (2009) Prevalence of Metabolic Syndrome Among Adults 20 years of Age and Over, By Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003–2006. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
41Foster, GD, Wyatt, HR, Hill, JO, et al. (2010) Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 153, 147157.
42Volek, JS, Sharman, MJ & Forsythe, CE (2005) Modification of lipoproteins by very low-carbohydrate diets. J Nutr 135, 13391342.
43Bravata, DM, Sanders, L, Huang, J, et al. (2003) Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 289, 18371850.
44Yancy, WS Jr, Olsen, MK, Guyton, JR, et al. (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 140, 769777.
45Schrier, RW (2008) Blood urea nitrogen and serum creatinine: not married in heart failure. Circ Heart Fail 1, 25.
46Mason, JE, Starke, RD & Van Kirk, JE (2010) Gamma-glutamyl transferase: a novel cardiovascular risk biomarker. Prev Cardiol 13, 3641.


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