A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity.
OBJECTIVE
To compare the effects of a low-carbohydrate diet and a conventional (fat- and calorie-restricted) diet on lipoprotein subfractions and inflammation in severely obese subjects.


METHODS
We compared changes in lipoprotein subfractions and C-reactive protein levels in 78 severely obese subjects, including 86% with either diabetes or metabolic syndrome, who were randomly assigned to either a low-carbohydrate or conventional diet for 6 months.


RESULTS
Subjects on a low-carbohydrate diet experienced a greater decrease in large very low-density lipoprotein (VLDL) levels (difference = -0.26 mg/dL, P = 0.03) but more frequently developed detectable chylomicrons (44% vs. 22%, P = 0.04). Both diet groups experienced similar decreases in the number of low-density lipoprotein (LDL) particles (difference = -30 nmol/L, P = 0.74) and increases in large high-density lipoprotein (HDL) concentrations (difference = 0.70 mg/dL, P = 0.63). Overall, C-reactive protein levels decreased modestly in both diet groups. However, patients with a high-risk baseline level (>3 mg/dL, n = 48) experienced a greater decrease in C-reactive protein levels on a low-carbohydrate diet (adjusted difference = -2.0 mg/dL, P = 0.005), independent of weight loss.


CONCLUSIONS
In this 6-month study involving severely obese subjects, we found an overall favorable effect of a low-carbohydrate diet on lipoprotein subfractions, and on inflammation in high-risk subjects. Both diets had similar effects on LDL and HDL subfractions.
Seshadri
Prakash
P
Department of Internal Medicine, Division of Endocrinology, University of Pennsylvania Health System, Philadelphia 19104, USA.
Iqbal
Nayyar
N
Stern
Linda
L
Williams
Monica
M
Chicano
Kathryn L
KL
Daily
Denise A
DA
McGrory
Joyce
J
Gracely
Edward J
EJ
Rader
Daniel J
DJ
Samaha
Frederick F
FF
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism*; D031204:Caloric Restriction; D002914:Chylomicrons / Q000187:drug effects / Q000378:metabolism; D003920:Diabetes Mellitus / Q000178:diet therapy / Q000453:epidemiology / Q000378:metabolism; D018752:Diet, Fat-Restricted; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008074:Lipoproteins / Q000187:drug effects / Q000378:metabolism*; D008075:Lipoproteins, HDL / Q000187:drug effects / Q000378:metabolism; D008077:Lipoproteins, LDL / Q000187:drug effects / Q000378:metabolism; D008079:Lipoproteins, VLDL / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy* / Q000453:epidemiology / Q000378:metabolism*; D010414:Pennsylvania; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss
D015415:Biomarkers; D002914:Chylomicrons; D004040:Dietary Carbohydrates; D000960:Hypolipidemic Agents; D008074:Lipoproteins; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D008079:Lipoproteins, VLDL; D002097:C-Reactive Protein