A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity_540008091.pdf

original article The new england journal of medicine n engl j med 348;21 may 22, 2003 2074 A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D. From the Philadelphia Veterans Affairs Med- ical Center (F.F.S., N.I., K.L.C., D.A.D., J.M., T.W., M.W., L.S.); the Department of Med- icine, Division of Cardiology (F.F.S.), and the Department of Medicine, Division of Endocrinology (N.I., P.S.), University of Pennsylvania Medical Center; and the De- partment of Family, Community, and Pre- ventive Medicine, Drexel University College of Medicine (E.J.G.) — all in Philadelphia. Address reprint requests to Dr. Samaha at Cardiology 8th Fl., MC 111C, University and Woodland Ave., Philadelphia, PA 19104, or at rick.samaha@. N Engl J Med 2003;348:2074-81. Copyright ? 2003 Massachusetts Medical Society. background The effects of a carbohydrate-restricted diet on weight loss and risk factors for athero- sclerosis have been incompletely assessed. methods We randomly assigned 132 severely obese subjects (including 77 blacks and 23 wom- en) with a mean body-mass index of 43 and a high prevalence of diabetes (39 percent) or the metabolic syndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate) diet or a calorie- and fat-restricted (low-fat) diet. results Seventy-nine subjects completed the six-month study. An analysis including all sub- jects, with the last observation carried forward for those who dropped out, showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet (mean [ ± SD], –5.8 ± 8.6 kg vs. –1.9 ± 4.2 kg; P=0.002) and had greater decreases in tri- glyceride levels (mean, –20 ± 43 percent vs. –4 ± 31 per