Points 1, 21, 22
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates
ResultsAt 6 months, participants assigned to each diet had lost an average of 6 kg, which represented 7% of their initial weight; they began to regain weight after 12 months. By 2 years, weight loss remained similar in those who were assigned to a diet with 15% protein and those assigned to a diet with 25% protein (3.0 and 3.6 kg, respectively); in those assigned to a diet with 20% fat and those assigned to a diet with 40% fat (3.3 kg for both groups); and in those assigned to a diet with 65% carbohydrates and those assigned to a diet with 35% carbohydrates (2.9 and 3.4 kg, respectively) (P>0.20 for all comparisons). Among the 80% of participants who completed the trial, the average weight loss was 4 kg; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. Satiety, hunger, satisfaction with the diet, and attendance at group sessions were similar for all diets; attendance was strongly associated with weight loss (0.2 kg per session attended). The diets improved lipid-related risk factors and fasting insulin levels.
ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.
Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets
Low-carbohydrate diets may promote greater weight loss than does the conventional low-fat, high-carbohydrate diet.
We compared weight loss and biomarker change in adults adhering to a ketogenic low-carbohydrate (KLC) diet or a nonketogenic low-carbohydrate (NLC) diet.
Twenty adults [body mass index (in kg/m): 34.4 ± 1.0] were randomly assigned to the KLC (60% of energy as fat, beginning with ≈5% of energy as carbohydrate) or NLC (30% of energy as fat; ≈40% of energy as carbohydrate) diet. During the 6-wk trial, participants were sedentary, and 24-h intakes were strictly controlled.
Mean (±SE) weight losses (6.3 ± 0.6 and 7.2 ± 0.8 kg in KLC and NLC dieters, respectively; P = 0.324) and fat losses (3.4 and 5.5 kg in KLC and NLC dieters, respectively; P = 0.111) did not differ significantly by group after 6 wk. Blood ß-hydroxybutyrate in the KLC dieters was 3.6 times that in the NLC dieters at week 2 (P = 0.018), and LDL cholesterol was directly correlated with blood ß-hydroxybutyrate (r = 0.297, P = 0.025). Overall, insulin sensitivity and resting energy expenditure increased and serum γ-glutamyltransferase concentrations decreased in both diet groups during the 6-wk trial (P < 0.05). However, inflammatory risk (arachidonic acid:eicosapentaenoic acid ratios in plasma phospholipids) and perceptions of vigor were more adversely affected by the KLC than by the NLC diet.
KLC and NLC diets were equally effective in reducing body weight and insulin resistance, but the KLC diet was associated with several adverse metabolic and emotional effects. The use of ketogenic diets for weight loss is not warranted.
Points 1, 21, 37
Meal frequency and energy balance.
Several epidemiological studies have observed an inverse relationship between people's habitual frequency of eating and body weight, leading to the suggestion that a 'nibbling' meal pattern may help in the avoidance of obesity. A review of all pertinent studies shows that, although many fail to find any significant relationship, the relationship is consistently inverse in those that do observe a relationship. However, this finding is highly vulnerable to the probable confounding effects of post hoc changes in dietary patterns as a consequence of weight gain and to dietary under-reporting which undoubtedly invalidates some of the studies. We conclude that the epidemiological evidence is at best very weak, and almost certainly represents an artefact. A detailed review of the possible mechanistic explanations for a metabolic advantage of nibbling meal patterns failed to reveal significant benefits in respect of energy expenditure. Although some short-term studies suggest that the thermic effect of feeding is higher when an isoenergetic test load is divided into multiple small meals, other studies refute this, and most are neutral. More importantly, studies using whole-body calorimetry and doubly-labelled water to assess total 24 h energy expenditure find no difference between nibbling and gorging. Finally, with the exception of a single study, there is no evidence that weight loss on hypoenergetic regimens is altered by meal frequency.
We conclude that any effects of meal pattern on the regulation of body weight are likely to be mediated through effects on the food intake side of the energy balance equation.
Increased meal frequency does not promote greater weight loss in subjects who were prescribed an 8-week equi-energetic energy-restricted diet.
There have been reports of an inverse relationship between meal frequency (MF) and adiposity. It has been postulated that this may be explained by favourable effects of increased MF on appetite control and possibly on gut peptides as well. The main goal of the present study was to investigate whether using a high MF could lead to a greater weight loss than that obtained with a low MF under conditions of similar energy restriction. Subjects were randomised into two treatment arms (high MF = 3 meals+3 snacks/d or low MF = 3 meals/d) and subjected to the same dietary energy restriction of - 2931 kJ/d for 8 weeks. Sixteen obese adults (n 8 women and 8 men; age 34.6 (sd 9.5); BMI 37.1 (sd 4.5) kg/m2) completed the study. Overall, there was a 4.7 % decrease in body weight (P < 0.01); similarly, significant decreases were noted in fat mass ( - 3.1 (sd 2.9) kg; P < 0.01), lean body mass ( - 2.0 (sd 3.1) kg; P < 0.05) and BMI ( - 1.7 (sd 0.8) kg/m2; P < 0.01). However, there were NS differences between the low- and high-MF groups for adiposity indices, appetite measurements or gut peptides (peptide YY and ghrelin) either before or after the intervention.
We conclude that increasing MF does not promote greater body weight loss under the conditions described in the present study.