Short-term changes in lipoprotein subclasses and C-reactive protein levels of hypertriglyceridemic adults on low-carbohydrate and low-fat diets. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Effects of a Monounsaturated Fatty Acid–Enriched Hypocaloric Diet on Cardiovascular Risk Factors in Obese Patients With Type 2 Diabetes Weight loss with high and low carbohydrate 1200 kcal diets in free living women Liver Fat Is Reduced by an Isoenergetic MUFA Diet in a Controlled Randomized Study in Type 2 Diabetic Patients One-Year Comparison of a High–Monounsaturated Fat Diet With a High-Carbohydrate Diet in Type 2 Diabetes Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition, and fat distribution in older men and women: a randomized controlled trial. Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: A randomized clinical trial Altering source or amount of dietary carbohydrate has acute and chronic effects on postprandial glucose and triglycerides in type 2 diabetes: Canadian trial of Carbohydrates in Diabetes (CCD). Daily physical activity and macronutrient distribution of low-calorie diets jointly affect body fat reduction in obese women. The effect of sucrose content in high and low carbohydrate diets on plasma glucose, insulin, and lipid responses in hypertriglyceridemic humans. A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults. Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Role of carbohydrate modification in weight management among obese children: a randomized clinical trial. High carbohydrate and high monounsaturated fatty acid diets similarly affect LDL electrophoretic characteristics in men who are losing weight. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Potentiation of Effects of Weight Loss by Monounsaturated Fatty Acids in Obese NIDDM Patients High Glycemic Index Carbohydrate Diet Alters the Diurnal Rhythm of Leptin But Not Insulin Concentrations
Diets design ed to promote weight loss and improve atherogenic lipid profiles traditionally include a reduction in total fat and , in particular , saturated fats . This study was design ed to test the efficacy of a low-fat diet vs a carbohydrate (CHO)-restricted ( low-CHO ) diet in hypertriglyceridemic patients on lipid profile , weight loss , high-sensitivity C-reactive protein ( hs-CRP ) , and satiety .  Twenty-eight hypertriglyceridemic subjects ( based on fasting triacylglycerol [ TG ] levels exceeding 1.69 mmol/L ) were r and omized to either the  low-CHO or low-fat diet  for 8 weeks . Fasting bloods were acquired at weeks 0 and 8 and analyzed for lipids and hs-CRP . Body weight and other anthropometric measures were also obtained . Three r and om 24-hour food recalls were used to assess compliance during the trial and 2 recalls before r and omization to permit individualized dietary education . A significant time-by-treatment interaction was observed ( P = .045 ) , wherein the small low-density lipoprotein cholesterol concentrations were reduced by 46 % in the low-CHO-assigned subjects and increased by 36 % for those assigned the low-fat plan . The observed decrease in TG ( 18 % ) among low-CHO subjects , in contrast to the 4 % increase for low-fat group , was not significant , nor were there significant differences in hs-CRP , overall dietary compliance , satiety , or the magnitude of body weight loss between groups ( low-CHO group , -3.8 % vs low-fat group , -1.6 % ) . Favorable reductions in small low-density lipoprotein concentrations after 8 weeks suggest that a moderately restricted carbohydrate diet ( 20 % CHO as energy ) can promote a less atherogenic lipid profile when compared to the low-fat diet BACKGROUND The optimal source and amount of dietary carbohydrate for managing type 2 diabetes ( T2DM ) are unknown . OBJECTIVE We aim ed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin ( HbA1c ) , plasma glucose , lipids , and C-reactive protein ( CRP ) in T2DM patients . DESIGN Subjects with T2DM managed by diet alone ( n=162 ) were r and omly assigned to receive high-carbohydrate , high-glycemic-index ( high-GI ) , high-carbohydrate , low-glycemic-index ( low-GI ) , or low-carbohydrate , high-monounsaturated-fat ( low-CHO ) diets for 1 y. RESULTS The high-GI , low-GI , and low-CHO diets contained , respectively , 47 % , 52 % , and 39 % of energy as carbohydrate and 31 % , 27 % , and 40 % of energy as fat ; they had GIs of 63 , 55 , and 59 , respectively . Body weight and HbA1c did not differ significantly between diets . Fasting glucose was higher ( P=0.041 ) , but 2-h postload glucose was lower ( P=0.010 ) after 12 mo of the low-GI diet . With the low-GI diet , overall mean triacylglycerol was 12 % higher and HDL cholesterol 4 % lower than with the low-CHO diet ( P<0.05 ) , but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo ( time x diet interaction , P=0.044 ) . Overall mean CRP with the low-GI diet , 1.95 mg/L , was 30 % less than that with the high-GI diet , 2.75 mg/L ( P=0.0078 ) ; the concentration with the low-CHO diet , 2.35 mg/L , was intermediate . CONCLUSIONS In subjects with T2DM managed by diet alone with optimal glycemic control , long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate . Differences in total : HDL cholesterol among diets had disappeared by 6 mo . However , because of sustained reductions in postpr and ial glucose and CRP , a low-GI diet may be preferred for the dietary management of T2DM OBJECTIVE To determine whether the lipoprotein response to weight loss in obese patients with type 2 diabetes can be improved by modifying the macronutrient composition of the commonly prescribed low-fat , high-carbohydrate ( CHO ) hypocaloric diet . RESEARCH DESIGN AND METHODS Nine obese patients with type 2 diabetes were treated with a monounsaturated fatty acid (MUFA)-enriched weight-reducing formula diet and compared with eight obese patients with type 2 diabetes treated with a low-fat , high-CHO weight-reducing formula diet .  Weight loss ensued for 6 weeks , followed by 4 weeks of refeeding using isocaloric formulas enriched with MUFA or CHO , respectively . Fasting blood sample s were obtained to measure plasma lipoproteins and LDL susceptibility to oxidation ( measured as lag time : time required to induce in vitro formation of conjugated dienes ) . RESULTS At baseline , there were no differences between the groups in plasma lipids , lipoproteins , or LDL susceptibility to oxidation . Weight loss was similar between the groups . Dieting result ed in decreases in total plasma cholesterol , LDL , HDL , triglycerides , and apolipoproteins A and B ( P < 0.05 ) , but the MUFA group manifested a greater decrease in total cholesterol , triglycerides , and apolipoprotein B and a smaller decrease in HDL and apolipoprotein A than the CHO group ( P < 0.05 ) . Improvements in these parameters were sustained during refeeding . After dieting , lag time was prolonged in the MUFA group ( 208 ± 10 min ) compared with the CHO group ( 146 ± 11 min ; P < 0.05 ) . Lag time was prolonged further during refeeding in the MUFA group ( 221 ± 13 min , P = 0.10 ) , while the CHO group remained unchanged ( 152 ± 9 min , P < 0.05 ) . Lag time correlated strongly with the oleic acid content of LDL after dieting and refeeding ( r = 0.74 and r = 0.93 , respectively ; both P < 0.001 ) . CONCLUSIONS Macronutrient content is an important determinant of the lipoprotein response to weight loss in obese patients with type 2 diabetes . MUFA-enriched hypocaloric diets potentiate the beneficial effects of weight loss to ameliorate cardiovascular risk factors in obese patients with type 2 diabetes This r and omised controlled trial examined anthropometric changes and cardiovascular benefits of six months of weight management in 110 free living women , aged 18–68 y and BMI 25–50 kg/m2 , who received 1200 kcal/d diet treatments of either high ( 58 % energy , n=57 ) or low ( 35 % energy , n=53 ) carbohydrate ( CHO ) content .  Body weight , plasma total , HDL and LDL cholesterol , triglyceride and blood pressure were measured . Examination at three months showed women on high CHO lost ( mean±s.e.m . ) 4.3±0.5 kg and those on low CHO lost 5.6±0.6 kg of body weight . Changes in risk factors did not significantly differ between the two diet treatments throughout the study . However those on high CHO diets significantly lowered their plasma total cholesterol by 0.33 mmol/l ( 95 % CI : 0.10 , 0.55 ) , LDL cholesterol by 0.23 mmol/l ( 0.02 , 0.43 ) and HDL cholesterol by 0.05 mmol/l ( 0.03 , 0.10 ) , while women on low CHO diets lowered only plasma triglyceride by 0.28 mmol/l ( 0.08 , 0.48 ) . Blood pressure did not change significantly on either diet . After six months , women on high CHO lost 5.6±0.8 kg and those on low CHO lost 6.8±0.8 kg . On the high CHO  diet , total cholesterol remained significantly below the baseline value at 0.34 mmol/l ( 0.13 , 0.56 ) , triglyceride was significantly lowered by 0.27 mmol/l ( 0.10 , 0.45 ) , and HDL cholesterol returned to the baseline value . On the low CHO  diet , triglyceride remained the only risk factor to be significantly improved . A subgroup of 46 postmenopausal women lost significantly ( P<0.05 ) more weight on the low CHO diet than high CHO diet . In conclusion , these results provided some support for preferring a high CHO diet to a lower CHO approach in weight management , from the point of view of risk reduction , but do not indicate a consistently more rapid weight loss with either diet OBJECTIVE To evaluate the effects of qualitative dietary changes and the interaction with aerobic exercise training on liver fat content independent of weight loss in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS With use of a factorial 2 × 2 r and omized parallel-group design , 37 men and 8 women , aged 35–70 years , with type 2 diabetes in satisfactory blood glucose control on diet or diet plus metformin treatment  were assigned to one of the following groups for an 8-week period : 1 ) high-carbohydrate/high-fiber/low – glycemic index diet ( CHO/fiber group ) , 2 ) high-MUFA diet ( MUFA group ) , 3 ) high-carbohydrate/high-fiber/low – glycemic index diet plus physical activity program ( CHO/fiber+Ex group ) , and 4 ) high-MUFA diet plus physical activity program ( MUFA+Ex group ) . Before and after intervention , hepatic fat content was measured by 1H NMR . RESULTS Dietary compliance was optimal and body weight remained stable in all groups . Liver fat content decreased more in MUFA ( −29 % ) and MUFA+Ex ( −25 % ) groups than in CHO/fiber ( −4 % ) and CHO/fiber+Ex groups ( −6 % ) . Two-way repeated- measures ANOVA , including baseline values as covariate , showed a significant effect on liver fat content for diet ( P = 0.006 ) , with no effects for exercise training ( P = 0.789 ) or diet-exercise interaction ( P = 0.712 ) . CONCLUSIONS An isocaloric diet enriched in MUFA compared with a diet higher in carbohydrate and fiber was associated with a clinical ly relevant reduction of hepatic fat content in type 2 diabetic patients independent of an aerobic training program and should be considered for the nutritional management of hepatic steatosis in people with type 2 diabetes OBJECTIVE —The purpose of this study was to compare the effects of high – monounsaturated fatty acid ( MUFA ) and high-carbohydrate ( CHO ) diets on body weight and glycemic control in men and women with type 2 diabetes . RESEARCH DESIGN AND METHODS —Overweight/obese participants with type 2 diabetes ( n = 124 , age = 56.5 ± 0.8 years , BMI = 35.9 ± 0.3 kg/m2 , and A1C = 7.3 ± 0.1 % ) were r and omly assigned to 1 year of a high-MUFA or high-CHO diet . Anthropometric and metabolic parameters were assessed at baseline and after 4 , 8 , and 12 months of dieting . RESULTS —Baseline characteristics were similar between the treatment groups . The overall retention rate for 1 year was 77 % ( 69 % for the high-MUFA group and 84 % for the high-CHO group ; P = 0.06 ) . Based on food records , both groups had similar energy intake but a significant difference in MUFA intake . Both groups had similar weight loss over 1 year ( −4.0 ± 0.8 vs. −3.8 ± 0.6 kg ) and comparable improvement in body fat , waist circumference , diastolic blood pressure , HDL cholesterol , A1C , and fasting glucose and insulin . There were no differences in these parameters between the groups . A follow-up assessment of a subset of participants ( n = 36 ) was conducted 18 months after completion of the 52-week diet . These participants maintained their weight loss and A1C during the follow-up period . CONCLUSIONS —In individuals with type 2 diabetes  , high-MUFA diets are an alternative to conventional lower-fat , high-CHO diets with comparable beneficial effects on body weight , body composition , cardiovascular risk factors , and glycemic control AIMS To compare the effects of a high-carbohydrate ( CHO ) diet and a high-monounsaturated fatty acid ( MUFA ) diet on LDL oxidative resistance in free-living individuals with Type 2 diabetes mellitus . METHODS Twenty-two men and women out- patients with Type 2 diabetes , with mean age 61 years and in fair metabolic control ( HbA1c<8.0 % ) , were enrolled at a university hospital lipid clinic in a r and omized , crossover feeding trial comparing two isocaloric diets for 6 weeks each : CHO ( fat , 28 % energy ) and MUFA ( fat , 40 % energy ) based on virgin olive oil . Outcome measurements were changes in LDL susceptibility to oxidation , body weight , glycaemic control , and lipoprotein profiles . RESULTS Planned and observed diets were well matched . Participants preferred the MUFA diet over the CHO diet . The lag time of conjugated diene formation during Cu2 + -induced LDL oxidation was similar after the CHO and MUFA diets ( 36.4 + /- 12.2 min and 36.0 + /- 13.7 min , respectively ) . Body weight , glycaemic control , total triglycerides , and total , LDL- and HDL-cholesterol levels also were similar after the two diets . Compared with the CHO diet , the MUFA diet lowered VLDL-cholesterol by 35 % ( P=0.023 ) and VLDL triglyceride by 16 % ( P=0.016 ) . CONCLUSIONS Natural food-based high-CHO and high-MUFA diets have similar effects on LDL oxidative resistance and metabolic control in subjects with Type 2 diabetes . A MUFA diet is a good alternative to high-CHO diets for nutrition therapy of diabetes because it also has a beneficial effect on the lipid profile and superior patient acceptance Cl aims about the merits or risks of carbohydrate ( CHO ) vs. protein for weight loss diets are extensive , yet the ideal ratio of dietary carbohydrate to protein for adult health and weight management remains unknown . This study examined the efficacy of two weight loss diets with modified CHO/protein ratios to change body composition and blood lipids in adult women . Women ( n = 24 ; 45 to 56 y old ) with body mass indices > 26 kg/m(2 ) were assigned to either a CHO Group consuming a diet with a CHO/protein ratio of 3.5 ( 68 g protein/d ) or a Protein Group with a ratio of 1.4 ( 125 g protein/d ) . Diets were isoenergetic , providing 7100 kJ/d , and similar amounts of fat ( approximately 50 g/d ) . After consuming the diets for 10 wk , the CHO Group lost 6.96 + /- 1.36 kg body weight and the Protein Group lost 7.53 + /- 1.44 kg . Weight loss in the Protein Group was partitioned to a significantly higher loss of fat/lean ( 6.3 + /- 1.2 g/g ) compared with the CHO Group ( 3.8 + /- 0.9 ) . Both groups had significant reductions in serum cholesterol ( approximately 10 % ) , whereas the Protein Group also had significant reductions in triacylglycerols ( TAG ) ( 21 % ) and the ratio of TAG/HDL cholesterol ( 23 % ) . Women in the CHO Group had higher insulin responses to meals and postpr and ial hypoglycemia , whereas women in the Protein Group reported greater satiety . This study demonstrates that increasing the proportion of protein to carbohydrate in the diet of adult women has positive effects on body composition , blood lipids , glucose homeostasis and satiety during weight loss This study examined the interaction of 2 diets ( high protein , reduced carbohydrates vs. low protein , high carbohydrates ) with exercise on body composition and blood lipids in women ( n = 48 , approximately 46 y old , BMI = 33 kg/m(2 ) ) during weight loss . The study was a 4-mo weight loss trial using a 2 x 2 block design ( Diet x Exercise ) . Diets were equal in total energy ( 7.1 MJ/d ) and lipids ( approximately 30 % energy intake ) but differed in protein content and the ratio of carbohydrate : protein at 1.6 g/(kg . d ) and < 1.5 ( PRO group ) vs. 0.8 g/(kg . d ) and > 3.5 ( CHO group ) , respectively . Exercise comparisons were lifestyle activity ( control ) vs. a supervised exercise program ( EX : 5 d/wk walking and 2 d/wk resistance training ) . Subjects in the PRO and PRO + EX groups lost more total weight and fat mass and tended to lose less lean mass ( P = 0.10 ) than the CHO and CHO + EX groups . Exercise increased loss of body fat and preserved lean mass . The combined effects of diet and exercise were additive for improving body composition . Serum lipid profiles improved in all groups , but changes varied among diet treatments . Subjects in the CHO groups had larger reductions in total cholesterol and LDL cholesterol , whereas subjects in the PRO groups had greater reductions in triacylglycerol and maintained higher concentrations of HDL cholesterol . This study demonstrated that a diet with higher protein and reduced carbohydrates combined with exercise additively improved body composition during weight loss , whereas the effects on blood lipids differed between diet treatments BACKGROUND The efficacy of ad libitum low-fat diets in reducing body weight and fat in overweight and obese adults remains controversial . METHODS We examined the effect of a 12-week low-fat , high-complex carbohydrate diet alone ( HI-CHO ) and in combination with aerobic exercise training ( HI-CHO + EX ) on body weight and composition in 34 individuals with impaired glucose tolerance ( 20 women and 14 men ; mean + /- SEM age , 66 + /- 1 years ) . Participants were r and omly assigned to a control diet ( 41 % fat , 14 % protein , 45 % carbohydrates , and 7 g of fiber per 1000 kcal ) , a HI-CHO diet ( 18 % fat , 19 % protein , 63 % carbohydrates , and 26 g of fiber per 1000 kcal ) , or a HI-CHO diet plus endurance exercise 4 d/wk , 45 min/d , at 80 % peak oxygen consumption ( HI-CHO + EX ) . Participants were provided 150 % of estimated energy needs and were instructed to consume food ad libitum . Total food intake , body composition , resting metabolic rate , and substrate oxidation were measured . RESULTS There was no significant difference in total food intake among the 3 groups and no change in energy intake over time . The HI-CHO + EX and HI-CHO groups lost more body weight ( -4.8 + /- 0.9 kg [ P=.003 ] and -3.2 + /- 1.2 kg [ P=.02 ] ) and a higher percentage of body fat ( -3.5 % + /- 0.7 % [ P=.01 ] and -2.2 % + /- 1.2 % [ P=.049 ] ) than controls ( -0.1 + /- 0.6 kg and 0.2 % + /- 0.6 % ) . In addition , thigh fat area decreased in the HI-CHO ( P=.003 ) and HI-CHO + EX ( P<.001 ) groups compared with controls . High carbohydrate intake and weight loss did not result in a decreased resting metabolic rate or reduced fat oxidation . CONCLUSION A high-carbohydrate diet consumed ad libitum , with no attempt at energy restriction or change in energy intake , results in losses of body weight and body fat in older men and women Background . Due to the higher prevalence of obesity and diabetes mellitus ( DM ) , more pregnant women complicated with diabetes are in need of clinical care . Purpose . Compare the effect of including only low glycemic index ( GI ) carbohydrates ( CHO ) against all types of CHO on maternal glycemic control and on the maternal and newborn 's nutritional status of women with type 2 DM and gestational diabetes mellitus ( GDM ) . Methods . Women ( n = 107 , ≤29 weeks of gestation ) were r and omly assigned to one of two nutrition intervention groups : moderate energy and CHO restriction ( Group 1 : all types of CHO , Group 2 : low GI foods ) . Results . No baseline differences in clinical data were observed . Capillary glucose concentrations throughout pregnancy were similar between groups . Fewer women in Group 2 exceeded weight gain recommendations . Higher risk of prematurity was observed in women in Group 2 . No differences in glycemic control were observed between women with type 2 DM and those with GDM . Conclusions . Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO . This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity Background To evaluate the metabolic effects of two weight loss diets differing in macronutrient composition on features of dyslipidemia and post-pr and ial insulin ( INS ) response to a meal challenge in overweight/obese individuals . Methods This study was a parallel-arm r and omized 4 mo weight loss trial . Adults ( n = 50 , 47 ± 7 y ) matched on BMI ( 33.6 ± 0.6 kg/m2 , P = 0.79 )  consumed energy restricted diets ( deficit ~500 kcal/d ) : PRO ( 1.6 g.kg-1.d-1 protein and < 170 g/d carbohydrate ) or CHO ( 0.8 g.kg-1.d-1 protein and > 220 g/d carbohydrate ) for 4 mos . Meal challenges of respective diets were utilized for determination of blood lipids and post-pr and ial INS and glucose response at the beginning and end of the study . Results There was a trend for PRO to lose more weight ( -9.1 % vs. -7.3 % , P = 0.07 ) with a significant reduction in percent fat mass compared to CHO ( -8.7 % vs. -5.7 % ; P = 0.03 ) . PRO also favored reductions in triacylglycerol ( -34 % vs. -14 % ; P < 0.05 ) and increases in HDL-C ( + 5 % vs. -3 % ; P = 0.05 ) ; however , CHO favored reduction in LDL-C ( -7 % vs. + 2.5 % ; P < 0.05 ) . INS responses to the meal challenge were improved in PRO compared to CHO ( P < 0.05 ) at both 1 hr ( -34.3 % vs. -1.0 % ) and 2 hr ( -9.2 % vs. + 46.2 % ) , an effect that remained significant after controlling for weight or fat loss ( both P < 0.05 ) . Conclusion A weight loss diet with moderate carbohydrate , moderate protein results in more favorable changes in body composition , dyslipidemia , and post-pr and ial INS response compared to a high carbohydrate , low protein diet suggesting an additional benefit beyond weight management to include augmented risk reduction for metabolic disease BACKGROUND AND AIMS Nutrition recommendations for type 2 diabetes ( T2DM ) are partly guided by the postpr and ial responses elicited by diets varying in carbohydrate ( CHO ) . We aim ed to explore whether long-term changes in postpr and ial responses on low-glycemic-index ( GI ) or low-CHO diets were due to acute or chronic effects in T2DM . METHODS AND RESULTS Subjects with diet-alone-treated T2DM were r and omly assigned to high-CHO/high-GI ( H ) , high-CHO/low-GI ( L ) , or low-CHO/high-monounsaturated-fat ( M ) diets for 12-months . At week-0 ( Baseline ) postpr and ial responses after H-meals ( 55 % CHO , GI = 61 ) were measured from 0800 h to 1600 h. After 12 mo subjects were r and omly assigned to H-meals or study diet meals ( L , 57 % CHO , GI = 50 ; M , 44 % CHO , GI = 61 ) . This yielded 5 groups : H diet with H-meals ( HH , n = 34 ) ; L diet with H- ( LH , n = 17 ) or L-meals ( LL , n = 16 ) ; and M diet with H- ( MH , n = 18 ) or M meals ( MM , n = 19 ) . Postpr and ial glucose fluctuations were lower in LL than all other groups ( p < 0.001 ) . Changes in postpr and ial-triglycerides differed among groups ( p < 0.001 ) . After 12 mo in HH and MM both fasting- and postpr and ial-triglycerides were similar to Baseline while in MH postpr and ial-triglycerides were significantly higher than at Baseline ( p = 0.028 ) . In LH , triglycerides were consistently ( 0.18 - 0.34 mmol/L ) higher than Baseline throughout the day , while in LL the difference from Baseline varied across the day from 0.04 to 0.36 mmol/L ( p < 0.001 ) . CONCLUSION Low-GI and low-CHO diets have both acute and chronic effects on postpr and ial glucose and triglycerides in T2DM subjects . Thus , the composition of the acute test-meal and the habitual diet should be considered when interpreting the nutritional implication s of different postpr and ial responses Inadequate dietary patterns and sedentary lifestyles are believed to be important factors in predisposing people to obesity . This study analyzed the potential interaction between habitual physical activity and the carbohydrate (CHO)-fat distribution in 2 hypocaloric diets and the impact of such interplay on body composition changes . Forty healthy obese women , 20 - 50 years old , were r and omly assigned to a high- or low-CHO energy-restricted diet , which was low or high in fat , respectively , during 10 weeks . Baseline and final measurements were performed to assess dietary habits , resting metabolic rate , and body composition changes . Physical activity was measured with a triaxial accelerometer and with a question naire . There were no significant differences in anthropometric and metabolic variables between both dietary groups at baseline . However , there was a positive correlation between total free-living physical activity and arm muscle preservation after 10 weeks ( r = 0.371 ; p = 0.024 ) . Interestingly , an interaction between macronutrient ( CHO-fat distribution ) intake and physical activity was found , since less-active subjects with a high-CHO-low-fat diet showed a greater fat loss than those more active with a lower-CHO-high-fat diet , whereas more-active subjects with a high-CHO-low-fat diet showed a smaller fat loss than those receiving a low-CHO-high-fat diet . Physical activity and the macronutrient content of energy-restricted diets , when design ed to promote body fat mass reduction , should be considered together to better predict the outcome To further underst and the effect of high carbohydrate (CHO)-low fat diets and the role of variations in dietary sucrose on CHO and lipid metabolism , 10 patients with hypertriglyceridemia were fed 2 isocaloric , typical American diets , containing 40 % and 60 % CHO , for 15 days in r and om sequence . Each patient was their own control , and they were divided into 2 groups of 5 patients each . In one group , sucrose was held constant at 13 % of total calories ( 40 - 13 % and 60 - 13 % ) , whereas the sucrose content was 9 % of the total calories on a 40 % CHO diet ( 40 - 9 % ) , and 15 % of total calories on a 60 % CHO diet ( 60 - 15 % ) in the other group . Fasting and postpr and ial blood sample s were analyzed for plasma glucose , insulin , cholesterol ( Chol ) , and triglycerides ( TG ) , as well as for Chol and TG in chylomicrons , very low density , low density , and high density lipoproteins ( HDL ) . Fasting plasma TG levels were significantly increased in both groups on the 60 % CHO diet , primarily due to increases in very low density-TG concentration . The magnitude of the elevation was attenuated when sucrose content was kept constant . Postpr and ial TG responses were qualitatively similar . There were no significant changes in plasma Chol concentrations , except for a modest fall in plasma HDL-Chol level after the 60 - 13 % diet period ( P less than 0.05 ) . No significant differences were found in fasting plasma glucose or insulin concentration . However , postpr and ial glucose and insulin responses were increased on both high CHO diets . The results of these studies demonstrate that high CHO-low fat diets , in general , tend to elevate plasma glucose , insulin , and TG concentrations and reduce HDL-Chol concentration in patients with endogenous hypertriglyceridemia . In addition , these data illustrate the important role that small variations in dietary sucrose can play in modulation of CHO and lipid metabolism Diets with increased protein and reduced carbohydrates ( PRO ) are effective for weight loss , but the long-term effect on maintenance is unknown . This study compared changes in body weight and composition and blood lipids after short-term weight loss ( 4 mo ) followed by weight maintenance ( 8 mo ) using moderate PRO or conventional high-carbohydrate ( CHO ) diets .  Participants ( age = 45.4 + /- 1.2 y ; BMI = 32.6 + /- 0.8 kg/m(2 ) ; n = 130 ) were r and omized to 2 energy-restricted diets ( -500 kcal/d or -2093 kJ/d ) : PRO with 1.6 g x kg(-1 ) x d(-1 ) protein and < 170 g/d carbohydrates or CHO with 0.8 g x kg(-1 ) x d(-1 ) protein , > 220 g/d carbohydrates . At 4 mo , the PRO group had lost 22 % more fat mass ( FM ) ( -5.6 + /- 0.4 kg ) than the CHO group ( -4.6 + /- 0.3 kg ) but weight loss did not differ between groups ( -8.2 + /- 0.5 kg vs. -7.0 + /- 0.5 kg ; P = 0.10 ) . At 12 mo , the PRO group had more participants complete the study ( 64 vs. 45 % , P < 0.05 ) with greater improvement in body composition ; however , weight loss did not differ between groups ( -10.4 + /- 1.2 kg vs. -8.4 + /- 0.9 kg ; P = 0.18 ) . Using a compliance criterion of participants attaining > 10 % weight loss , the PRO group had more participants ( 31 vs. 21 % ) lose more weight ( -16.5 + /- 1.5 vs. -12.3 + /- 0.9 kg ; P < 0.01 ) and FM ( -11.7 + /- 1.0 vs. -7.9 + /- 0.7 kg ; P < 0.01 ) than the CHO group . The CHO diet reduced serum cholesterol and LDL cholesterol compared with PRO ( P < 0.01 ) at 4 mo , but the effect did not remain at 12 mo . PRO had sustained favorable effects on serum triacylglycerol ( TAG ) , HDL cholesterol ( HDL-C ) , and TAG : HDL-C compared with CHO at 4 and 12 mo ( P < 0.01 ) . The PRO diet was more effective for FM loss and body composition improvement during initial weight loss and long-term maintenance and produced sustained reductions in TAG and increases in HDL-C compared with the CHO diet OBJECTIVE One of the goals in treating patients with chronic obstructive pulmonary disease ( COPD ) who suffer from hypoxemia , hypercapnia , and malnutrition is to correct the malnutrition without increasing the respiratory quotient and minimize the production of carbon dioxide . This 3-wk study evaluated the efficacy of feeding a high-fat , low-carbohydrate ( CHO ) nutritional supplement as opposed to a high-carbohydrate diet in COPD patients on parameters of pulmonary function . S METHODS : Sixty COPD patients with low body weight ( < 90 % ideal body weight ) were r and omized to the control group , which received dietary counseling for a high-CHO diet ( 15 % protein , 20 % to 30 % fat , and 60 % to 70 % CHO ) , or the experimental group , which received two to three cans ( 237 mL/can ) of a high-fat , low-CHO oral supplement ( 16.7 % protein , 55.1 % fat , and 28.2 % CHO ) in the evening as part of the diet . Measurements of lung function ( forced expiratory volume in 1 s or volume of air exhaled in 1 s of maximal expiration , minute ventilation , oxygen consumption per unit time , carbon dioxide production in unit time , and respiratory quotient ) and blood gases ( pH , arterial carbon dioxide tension , and arterial oxygen tension ) were taken at baseline and after 3 wk . RESULTS Lung function measurements decreased significantly and forced expiratory volume increased significantly in the experimental group . CONCLUSION This study demonstrates that pulmonary function in COPD patients can be significantly improved with a high-fat , low-CHO oral supplement as compared with the traditional high-CHO diet OBJECTIVE To determine the effect of a high-protein ( HP ) weight loss diet compared with a lower-protein ( LP ) diet on fat and lean tissue and fasting and postpr and ial glucose and insulin concentrations . RESEARCH DESIGN AND METHODS Replacing dietary protein for carbohydrate ( CHO ) during energy restriction and weight loss has been effective in sparing lean mass and improving insulin sensitivity in obese subjects but has not been tested in subjects with type 2 diabetes . We compared an HP diet ( 28 % protein , 42 % CHO , 28 % fat [ 8 % saturated fatty acids , 12 % monounsaturated fatty acids , 5 % polyunsaturated fatty acids ] ) with an LP diet ( 16 % protein , 55 % CHO , 26 % fat [ 8 % saturated fatty acids , 11 % monounsaturated fatty acids , 5 % polyunsaturated fatty acids ] ) in 54 obese men and women with type 2 diabetes during 8 weeks of energy restriction ( 1,600 kcal ) and 4 weeks of energy balance . Body composition was determined by dual-energy X-ray absorptiometry at weeks 0 and 12 . RESULTS Overall , weight loss of 5.2 + /- 1.8 kg was achieved independently of diet composition . However , women on the HP diet lost significantly more total ( 5.3 vs. 2.8 kg , P=0.009 ) and abdominal ( 1.3 vs. 0.7 kg , P=0.006 ) fat compared with the women on the LP diet , whereas , in men , there was no difference in fat loss between diets ( 3.9 vs. 5.1 kg ) . Total lean mass decreased in all subjects independently of diet composition . LDL cholesterol reduction was significantly greater on the HP diet ( 5.7 % ) than on the LP diet ( 2.7 % ) ( P < 0.01 ) . CONCLUSIONS Both dietary patterns result ed in improvements in the cardiovascular disease ( CVD ) risk profile as a consequence of weight loss . However , the greater reductions in total and abdominal fat mass in women and greater LDL cholesterol reduction observed in both sexes on the HP diet suggest that it is a valid diet choice for reducing CVD risk in type 2 diabetes OBJECTIVE To compare the effectiveness and safety of carbohydrate (CHO)-modified diets with a st and ard portion-controlled ( PC ) diet in obese children . STUDY DESIGN Obese children ( n=102 ) aged 7 - 12 years were r and omly assigned to a 3-month intervention of a low-CHO ( LC ) , reduced glycemic load ( RGL ) , or st and ard PC diet , along with weekly dietary counseling and biweekly group exercise .  Anthropometry , dietary adherence , and clinical measures were evaluated at baseline and 3 , 6 , and 12 months . Analyses applied intention-to-treat longitudinal mixed models . RESULTS Eighty-five children ( 83 % ) completed the 12-month assessment . Daily caloric intake decreased from baseline to all time points for all diet groups ( P<.0001 ) , although LC diet adherence was persistently lower ( P<.0002 ) . At 3 months , body mass index z score was lower in all diet groups ( LC , -0.27 ± 0.04 ; RGL , -0.20 ± 0.04 ; PC , -0.21 ± 0.04 ; P<.0001 ) and was maintained at 6 months , with similar results for waist circumference and percent body fat . At 12 months , participants in all diet groups had lower body mass index z scores than at baseline ( LC , -0.21 ± 0.04 ; RGL , -0.28 ± 0.04 ; PC , -0.31 ± 0.04 ; P<.0001 ) , and lower percent body fat , but no reductions in waist circumference were maintained . All diets demonstrated some improved clinical measures . CONCLUSION Diets with modified CHO intake were as effective as a PC diet  for weight management in obese children . However , the lower adherence to the LC diet suggests that this regimen is more difficult for children to follow , particularly in the long term We compared the effects of ad libitum consumption of a defined high complex carbohydrate ( CHO ) diet ( % of energy : CHO , 58.3 ; fat , 25.8 ) vs. a defined high monounsaturated fatty acid ( MUFA ) diet ( % of energy : CHO , 44.7 ; fat , 40.1 ; MUFA , 22.5 ) on LDL electrophoretic characteristics . Healthy men [ n = 65 ; age , 37.5 + /- 11.2 ( mean + /- SD ) y ; BMI , 29.2 + /- 4.9 kg/m2 ] were r and omly assigned to one of the two diets that they consumed for 6 - 7 wk . The high CHO diet significantly reduced body weight ( -2 % ) . The diet-induced reduction in plasma LDL cholesterol ( C ) levels in the high-CHO diet group was due mainly to concurrent reductions in the cholesterol content of small ( < 25.5 nm , P < 0.01 ) and medium-sized LDL ( 25.5 - 26.0 nm , P = 0.01 ) . The high MUFA diet also reduced body weight , and LDL-C and LDL-apolipoprotein (apo)B levels , which were comparable to those in the high CHO group . The cholesterol levels of small LDL particles tended to be reduced ( P = 0.24 ) in the high MUFA group ( -12 % ) , similar to changes in the high CHO group . These results suggest that , when associated with weight loss , ad libitum consumption of high CHO and high MUFA diets may be considered to be equally beneficial for the management of LDL-related atherogenic dyslipidemia . However , the high MUFA diet more favorably affected triglyceride levels , suggesting that it may be preferable to a high CHO diet in cardiovascular disease prevention OBJECTIVE To determine whether macronutrient composition of a hypocaloric diet can enhance its effectiveness and whether insulin sensitivity ( Si ) affects the response to hypocaloric diets . RESEARCH METHODS AND PROCEDURES Obese nondiabetic insulin-sensitive ( fasting insulin < 10 microU/mL ; n = 12 ) and obese nondiabetic insulin-resistant ( fasting insulin > 15 microU/mL ; n = 9 ) women ( 23 to 53 years old ) were r and omized to either a high carbohydrate ( CHO ) (HC)/low fat ( LF ) ( 60 % CHO , 20 % fat ) or low CHO (LC)/high fat ( HF ) ( 40 % CHO , 40 % fat ) hypocaloric diet . Primary outcome measures after a 16-week dietary intervention were : changes in body weight ( BW ) , Si , resting metabolic rate , and fasting lipids . RESULTS Insulin-sensitive women on the HC/LF diet lost 13.5 + /- 1.2 % ( p < 0.001 ) of their initial BW , whereas those on the LC/HF diet lost 6.8 + /- 1.2 % ( p < 0.001 ; p < 0.002 between the groups ) . In contrast , among the insulin-resistant women , those on the LC/HF diet lost 13.4 + /- 1.3 % ( p < 0.001 ) of their initial BW as compared with 8.5 + /- 1.4 % ( p < 0.001 ) lost by those on the HC/LF diet ( p < 0.04 between two groups ) . These differences could not be explained by changes in resting metabolic rate , activity , or intake . Overall , changes in Si were associated with the degree of weight loss ( r = -0.57 , p < 0.05 ) . DISCUSSION The state of Si determines the effectiveness of macronutrient composition of hypocaloric diets in obese women . For maximal benefit , the macronutrient composition of a hypocaloric diet may need to be adjusted to correspond to the state of Si Although moderate weight loss improves glycemic control in obese NIDDM patients , quite often it is not normalized . To determine whether the response to weight loss can be improved by altering the macronutrient composition of hypocaloric diets , 17 obese NIDDM patients were studied at 1 ) baseline , 2 ) after dieting for 6 weeks on a formula diet enriched in either monounsaturated fatty acids ( MUFAs , n = 9 ) or carbohydrates ( CHOs , n = 8) at a 50 % caloric deficit , and 3 ) after 4 weeks of postdiet refeeding on the respective formulas with caloric intake titrated to achieve weight maintenance . Fasting , 24-h , and oral glucose tolerance test ( OGTT ) blood glucose , plasma insulin , and C-peptide levels were measured . All prediet parameters were similar between groups . After dieting , although weight loss was similar between groups , the fasting glucose level decreased significantly more in the MUFA group ( −4.6 ± 0.7 mmol/l ) than in the CHO group ( −2.4 ± 1.0 mmol/l ; P < 0.05 ) . Twenty-four – hour glycemia decreased in both groups after dieting , but the MUFA group had a greater decrease than the CHO group ( P < 0.05 , analysis of variance [ ANOVA ] ) . Although decreases in fasting glycemia were maintained in both groups after refeeding , postpr and ial glycemia deteriorated after refeeding with the CHO- but not the MUFA-enriched formula ( P < 0.05 ) . After dieting and refeeding , fasting C-peptide increased 204 ± 47 pmol/l in the MUFA group , but the CHO group remained at prediet levels ( P < 0.05 ) . Twenty-four-hour C-peptide levels were similar between groups after dieting and refeeding , despite the lower glycemia and CHO content of the MUFA formula . However , when equal amounts of CHO were consumed during the OGTT , the MUFA group had significantly higher C-peptide levels after both dieting and refeeding ( P < 0.05 ) . Fasting , 24-h , and OGTT insulin levels were similar between groups throughout the study . These results indicate that macronutrient composition is an important determinant of the glycemic response to weight-loss therapy in obese NIDDM patients . Based on the C-peptide response during the OGTT , increased CHO-induced insulin secretion is one possible mechanism by which this occurs Morning  serum leptin values in humans are inconsistently altered by diet , and the molecular mechanisms controlling the diurnal leptin pattern remain unexplained . We determined whether leptin values after meals or the leptin diurnal pattern was altered by the type of carbohydrate ( CHO ) ingested in diets containing either 20 % or 30 % fat . In a r and omized , crossover study design , nine healthy lean adults ate one of four isocaloric diets for 8 days . Diets contained 15 % protein : A , high glycemic index ( GI ) CHO , 30 % fat ; B , low GI CHO , 30 % fat ; C , high GI CHO , 20 % fat ; and D , low GI CHO , 20 % fat .  Serum glucose , insulin , and leptin were measured at intervals on Day 8 for 24 hr , and on Day 9 during an oral glucose tolerance test ( GTT ) . Although the 24-hr glucose and insulin profiles did not differ with the diets , diets A and C altered the serum leptin diurnal pattern . In contrast to the usual evening rise in leptin concentration , which begins after 2200 hr , diets A and C caused a rise in leptin beginning at 1300 hr . The area under the curve for leptin between 1230 and 2400 hr was 17 % greater for diets A and C. During the GTT , leptin concentrations were similar for each diet . These results suggest that the pattern and amount of leptin secretion may be altered by high GI CHO or the simple sugar content of the diet , unrelated to differences in insulin concentration , that high GI foods may have little or no effect on serum insulin in the context of a mixed meal , and that a single 0800-hr leptin value may not be sufficient to reveal a diet-induced change in leptin
Based on the evidence review ed , low-CHO and very-low-CHO diets are not superior to other dietary approaches for weight loss .
These diets may have advantages related to appetite control , triglyceride reduction , and reduction in the use of medication in T2D management .
The evidence review ed showed mixed effects on low-density lipoprotein cholesterol levels with some studies showing an increase .
There was no clear evidence for advantages regarding effects on other cardiometabolic risk markers .
Historically , low-carbohydrate ( CHO ) and very-low-CHO diets have been used for weight loss .
Recently , these diets have been promoted for type 2 diabetes ( T2D ) management .
This scientific statement provides a comprehensive review of the current evidence base available from recent systematic review s and meta-analyses on the effects of low-CHO and very-low-CHO diets on body weight , lipoprotein lipids , glycemic control , and other cardiometabolic risk factors .