title: Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.
abstract: 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 (P<0.05 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 (P<0.05 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 (P<0.001 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 (P<0.001 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. (ClinicalTrials.gov number, NCT00160108.)
authors.affiliation: S. Daniel Abraham Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer-Sheva, Israel. irish@bgu.ac.il
authors.forename: Iris
authors.initials: I
authors.lastname: Shai
authors.forename: Dan
authors.initials: D
authors.lastname: Schwarzfuchs
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Henkin
authors.forename: Danit R
authors.initials: DR
authors.lastname: Shahar
authors.forename: Shula
authors.initials: S
authors.lastname: Witkow
authors.forename: Ilana
authors.initials: I
authors.lastname: Greenberg
authors.forename: Rachel
authors.initials: R
authors.lastname: Golan
authors.forename: Drora
authors.initials: D
authors.lastname: Fraser
authors.forename: Arkady
authors.initials: A
authors.lastname: Bolotin
authors.forename: Hilel
authors.initials: H
authors.lastname: Vardi
authors.forename: Osnat
authors.initials: O
authors.lastname: Tangi-Rozental
authors.forename: Rachel
authors.initials: R
authors.lastname: Zuk-Ramot
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sarusi
authors.forename: Dov
authors.initials: D
authors.lastname: Brickner
authors.forename: Ziva
authors.initials: Z
authors.lastname: Schwartz
authors.forename: Einat
authors.initials: E
authors.lastname: Sheiner
authors.forename: Rachel
authors.initials: R
authors.lastname: Marko
authors.forename: Esther
authors.initials: E
authors.lastname: Katorza
authors.forename: Joachim
authors.initials: J
authors.lastname: Thiery
authors.forename: Georg Martin
authors.initials: GM
authors.lastname: Fiedler
authors.forename: Matthias
authors.initials: M
authors.lastname: Blüher
authors.forename: Michael
authors.initials: M
authors.lastname: Stumvoll
authors.forename: Meir J
authors.initials: MJ
authors.lastname: Stampfer
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D038441:Diet, Mediterranean; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007659:Ketones / Q000652:urine; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000178:diet therapy* / Q000652:urine; D011795:Surveys and Questionnaires; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007659:Ketones; D008055:Lipids