Animal, Vegetable, or … Clinical Trial?
Authors: William S. Yancy
Journal: Annals of Internal Medicine (2010)

Editorials7 September 2010Animal, Vegetable, or … Clinical Trial?William S. Yancy Jr., MD, MHS, Matthew L. Maciejewski, PhD, and Kevin A. Schulman, MDWilliam S. Yancy Jr., MD, MHSFrom Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC 27705.Search for more papers by this author, Matthew L. Maciejewski, PhDFrom Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC 27705.Search for more papers by this author, and Kevin A. Schulman, MDFrom Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC 27705.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-5-201009070-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Several clinical trials in the past 10 years have demonstrated that a low-carbohydrate, high-fat, high-protein diet is at least as effective as a calorie-restricted, high-carbohydrate, low-fat diet for weight loss and improvement of risk factors (blood pressure, serum lipid levels, and glycemia) (1–3). These clinical trial results conflict with older observational studies that linked dietary fat with poor health outcomes. Newer observational studies and systematic reviews, however, have absolved fat (with the exception of trans fat) as a detriment to health, and some have implicated refined sugars and starches instead (4–8).In contrast to the increasingly robust understanding we have ...References1. Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet. A randomized trial. Ann Intern Med. 2010;153:147-57. [PMID: 20679559] LinkGoogle Scholar2. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-41. [PMID: 18635428] CrossrefMedlineGoogle Scholar3. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Brehm BJ, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:285-93. [PMID: 16476868] CrossrefMedlineGoogle Scholar4. Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002. [PMID: 17093250] CrossrefMedlineGoogle Scholar5. Mente A, deKoning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169:659-69. [PMID: 19364995] CrossrefMedlineGoogle Scholar6. Oh K, Hu FB, Manson JE, Stampfer MJ, Willett WC. Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. Am J Epidemiol. 2005;161:672-9. [PMID: 15781956] CrossrefMedlineGoogle Scholar7. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91:535-46. [PMID: 20071648] CrossrefMedlineGoogle Scholar8. Mozaffarian D, Rimm EB, Herrington DM. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women. Am J Clin Nutr. 2004;80:1175-84. [PMID: 15531663] CrossrefMedlineGoogle Scholar9. Fung TT, vanDam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality. Two cohort studies. Ann Intern Med. 2010;153:289-98. [PMID: 15531663] LinkGoogle Scholar10. Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Willett WC, Rosner B, et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med. 1996;335:453-61. [PMID: 8672166] CrossrefMedlineGoogle Scholar11. Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, et al; Women's Health Initiative Investigators. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003;349:523-34. [PMID: 12904517] CrossrefMedlineGoogle Scholar12. Howard BV, VanHorn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295:655-66. [PMID: 16467234] CrossrefMedlineGoogle Scholar13. Prentice RL, Caan B, Chlebowski RT, Patterson R, Kuller LH, Ockene JK, et al. Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295:629-42. [PMID: 16467232] CrossrefMedlineGoogle Scholar14. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd ed. Boston: Little, Brown; 1991. Google Scholar15. Stukel TA, Fisher ES, Wennberg DE. Using observational data to estimate treatment effects [Letter]. JAMA. 2007;297:2078-9. [PMID: 17507343] CrossrefMedlineGoogle Scholar16. Stukel TA, Fisher ES, Wennberg DE, Alter DA, Gottlieb DJ, Vermeulen MJ. Analysis of observational studies in the presence of treatment selection bias:effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA. 2007;297:278-85. [PMID: 17227979] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC 27705.Disclaimer: This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Medical Center in Durham, North Carolina. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.Grant Support: Dr. Yancy has received research grants from the Robert C. Atkins Foundation.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1774.Corresponding Author: William S. Yancy Jr., MD, MHS, Veterans Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705; e-mail, [email protected]duke.edu.Current Author Addresses: Drs. Yancy and Maciejewski: Veterans Affairs Medical Center, Mailstop 152, 508 Fulton Street, Durham, NC 27705.Dr. Schulman: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Carbohydrate Diets and All-Cause and Cause-Specific Mortality Teresa T. Fung , Rob M. van Dam , Susan E. Hankinson , Meir Stampfer , Walter C. Willett , and Frank B. Hu Animal, Vegetable, or … Clinical Trial? Teresa T. Fung , Walter C. Willett , and Frank B. Hu Metrics Cited byLessons Learned from the POUNDS Lost Study: Genetic, Metabolic, and Behavioral Factors Affecting Changes in Body Weight, Body Composition, and Cardiometabolic RiskFrom Hot Hands to Declining EffectsAnimal, Vegetable, or … Clinical Trial?Teresa T. Fung, ScD, Walter C. Willett, MD, DrPH, and Frank B. Hu, MD, PhDDo Low-Carb Diets Increase or Decrease Mortality? 7 September 2010Volume 153, Issue 5Page: 337-339KeywordsClinical trialsCohort studiesCongenital heart diseaseDietFatsHazard ratioMortalityObservational studiesPrevention, policy, and public healthProteins ePublished: 7 September 2010 Issue Published: 7 September 2010 PDF downloadLoading ...