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Low-carb and Mediterranean diets better than low-fat diet for weightloss



 
 
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Old July 19th, 2008, 02:29 PM posted to alt.support.diet.low-fat
Matti Narkia
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Posts: 19
Default Low-carb and Mediterranean diets better than low-fat diet for weightloss

The New England Journal of Medicine (NEJM) published a couple of days
ago the results of two-year randomized controlled clinical trial
(N=322)

Shai I et al.
Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.
The New England Journal of Medicine (NEJM), Volume 359:229-241,
July 17, 2008, Number 3
http://content.nejm.org/cgi/content/full/359/3/229

which compared the efficacy and health effects of low-carb,
Mediterranean and low-fat diets in weight loss. Below the abstract
of the study;

"Background Trials comparing the effectiveness and safety of
weight-loss diets are frequently limited by short follow-up times
and high dropout rates.

Methods In this 2-year trial, we randomly assigned 322 moderately
obese subjects (mean age, 52 years; mean body-mass index [the
weight in kilograms divided by the square of the height in '
meters], 31; male sex, 86%) to one of three diets: low-fat,
restricted-calorie; Mediterranean, restricted-calorie; or
low-carbohydrate, non–restricted-calorie.

Results The rate of adherence to a study diet was 95.4% at 1
year and 84.6% at 2 years. The Mediterranean-diet group
consumed the largest amounts of dietary fiber and had the
highest ratio of monounsaturated to saturated fat (P0.05
for all comparisons among treatment groups). The low-carbohydrate
group consumed the smallest amount of carbohydrates and the
largest amounts of fat, protein, and cholesterol and had the
highest percentage of participants with detectable urinary
ketones (P0.05 for all comparisons among treatment groups).
The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg
for the Mediterranean-diet group, and 4.7 kg for the
low-carbohydrate group (P0.001 for the interaction between
diet group and time); among the 272 participants who completed
the intervention, the mean weight losses were 3.3 kg, 4.6 kg,
and 5.5 kg, respectively. The relative reduction in the ratio
of total cholesterol to high-density lipoprotein cholesterol
was 20% in the low-carbohydrate group and 12% in the low-fat
group (P=0.01). Among the 36 subjects with diabetes, changes
in fasting plasma glucose and insulin levels were more favorable
among those assigned to the Mediterranean diet than among those
assigned to the low-fat diet (P0.001 for the interaction among
diabetes and Mediterranean diet and time with respect to fasting
glucose levels).

Conclusions Mediterranean and low-carbohydrate diets may be
effective alternatives to low-fat diets. The more favorable
effects on lipids (with the low-carbohydrate diet) and on
glycemic control (with the Mediterranean diet) suggest that
personal preferences and metabolic considerations might
inform individualized tailoring of dietary interventions."


The full text of the article seems also to be free, although to read
it a free registrations is probably required. Below a citation from
the Discussion chapter:

"In this 2-year dietary-intervention study, we found that the
Mediterranean and low-carbohydrate diets are effective alternatives
to the low-fat diet for weight loss and appear to be just as safe
as the low-fat diet. In addition to producing weight loss in this
moderately obese group of participants, the low-carbohydrate and
Mediterranean diets had some beneficial metabolic effects, a result
suggesting that these dietary strategies might be considered in
clinical practice and that diets might be individualized according
to personal preferences and metabolic needs. The similar caloric
deficit achieved in all diet groups suggests that a
low-carbohydrate, non–restricted-calorie diet may be optimal for
those who will not follow a restricted-calorie dietary regimen.
The increasing improvement in levels of some biomarkers over time
up to the 24-month point, despite the achievement of maximum weight
loss by 6 months, suggests that a diet with a healthful composition
has benefits beyond weight reduction."


News reports about this study:

Low-Carb and Mediterranean Diets Beat Low-Fat for Weight Loss, Lipid
Changes at 2 Years
http://www.medscape.com/viewarticle/577593?src=rss

(requires free registration)

Low-carb and Mediterranean diets beat low-fat for weight-loss, lipid
changes at two years
http://www.theheart.org/viewArticle.do?primaryKey=882281&nl_id=tho16jul08

Diet Debate: 3 Top Plans Go Toe to Toe
Researchers Say Mediterranean and Low-Carb Diets Are Good Alternatives
to Low-Fat Plan
http://www.webmd.com/diet/news/20080716/diet-debate-3-top-plans-go-toe-to-toe?src=RSS_PUBLIC
http://tinyurl.com/5vsvb8

Low-carb diet beats other diets in study
http://edition.cnn.com/2008/HEALTH/diet.fitness/07/16/dueling.diets.ap/index.html?eref=rss_health
http://tinyurl.com/6rhfnq

Low-carb beats low-fat in diet duel
Those eating fewer carbs also had lower cholesterol, surprising study finds
http://www.msnbc.msn.com/id/25708495/

Low-fat Diets May Not Be Best For Weight Loss, Study Suggests
http://www.sciencedaily.com/releases/2008/07/080716171134.htm

The two first news reports, by Medscape and www.theheart.org are
the best and almost identical. They are very clear and most detailed
and accurate of the all the news reports. They present some results
in easily readable table format. Here is their presentation of the
weight loss data:

"Weight loss

Group Low-fat (kg) Mediterranean (kg) Low-carb (kg)
All patients –2.9 –4.4 –4.7
All completers –3.3 –4.6 –5.5
Men –3.4 –4.0 –4.9
Women –0.1 –6.2 –2.4"

As can be seen the low-carb diet was best for men for weight loss,
followed by the Mediterranean diet, but Mediterranean diet was the
best for women, followed by the low-carb diet.

Their presentation of lipid changes is as follows:

"Lipid changes

Parameter Low-fat (mg/dL) Low-carb (mg/dL) Mediterranean (mg/dL)
HDL +6.4 +8.4 +6.3
LDL –0.05 –3.0 –5.6
Triglycerides –2.8 –23.7 –21.8
Total –0.6 –1.1 –0.9
cholesterol/
HDL ratio"

As can be seen, the important Total cholesterol/HDL ratio improved
most in the low-carb diet and the Mediterranean diet was very close
second. LDL was lowered most by Mediterranean diet followed by low-carb
diet. Low-carb diet raised HDL most. Triglycerides were lowered most
by low-carb and Mediterranean diets.

Finally, below some selected comments from the end of the Medscape
report:

"- The mean BMI changes were –1.0, –1.5, and –1.5 kg/m2, respectively.

- All groups had significant decreases in blood pressure and waist
circumference, with no difference among the 3 groups.

- Waist circumference was decreased by 2.8, 3.5, and 3.8 cm in the
low-fat, Mediterranean, and low-carbohydrate groups, respectively.

- Systolic blood pressure was reduced by 4.3, 5.5, and 3.9 mm Hg,
respectively.

- HDL cholesterol levels increased in all groups, with the greatest
increase in the low-carbohydrate group (8.4 mg/dL).

- Triglyceride levels decreased significantly, with the greatest
decrease seen in the low-carbohydrate group (2.7 mg/dL).

- The ratio of total to HDL cholesterol decreased in all 3 groups,
greatest in the low-carbohydrate group (20%).

- C-reactive protein decreased significantly in the Mediterranean and
low-carbohydrate groups.

- In the 36 participants with diabetes, only those in the Mediterranean
group had a significant reduction in fasting plasma glucose levels (32.8
mg/dL).

- Hemoglobin A1c rates decreased by 0.4%, 0.5%, and 0.9% in the low-fat,
Mediterranean, and low-carbohydrate groups, respectively.

- The Mediterranean and low-carbohydrate diets were feasible
alternatives to the low-fat diet with some benefits, and personal
preference could drive tailoring of diets for weight loss."

Notice especially that the very important cardiovascular risk factor
C-reactive protein (CRP) was reduced significantly only in the
Mediterranean and low-carbohydrate groups.


--
Matti Narkia

http://ma.gnolia.com/groups/Nutrition
 




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