title: Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial.
abstract: BACKGROUND
  Weight loss reduces body fat and lean mass, but whether these changes are influenced by macronutrient composition of the diet is unclear.
  
  
  OBJECTIVE
  We determined whether energy-reduced diets that emphasize fat, protein, or carbohydrate differentially reduce total, visceral, or hepatic fat or preserve lean mass.
  
  
  METHODS
  In a subset of participants in a randomized trial of 4 weight-loss diets, body fat and lean mass (n = 424; by using dual-energy X-ray absorptiometry) and abdominal and hepatic fat (n = 165; by using computed tomography) were measured after 6 mo and 2 y. Changes from baseline were compared between assigned amounts of protein (25% compared with 15%) and fat (40% compared with 20%) and across 4 carbohydrate amounts (35% through 65%).
  
  
  RESULTS
  At 6 mo, participants lost a mean (±SEM) of 4.2 ± 0.3 kg (12.4%) fat and 2.1 ± 0.3 kg (3.5%) lean mass (both P < 0.0001 compared with baseline values), with no differences between 25% and 15% protein (P ≥ 0.10), 40% and 20% fat (P ≥ 0.34), or 65% and 35% carbohydrate (P ≥ 0.27). Participants lost 2.3 ± 0.2 kg (13.8%) abdominal fat: 1.5 ± 0.2 kg (13.6%) subcutaneous fat and 0.9 ± 0.1 kg (16.1%) visceral fat (all P < 0.0001 compared with baseline values), with no differences between the diets (P ≥ 0.29). Women lost more visceral fat than did men relative to total-body fat loss. Participants regained ~40% of these losses by 2 y, with no differences between diets (P ≥ 0.23). Weight loss reduced hepatic fat, but there were no differences between groups (P ≥ 0.28). Dietary goals were not fully met; self-reported contrasts were closer to 2% protein, 8% fat, and 14% carbohydrate at 6 mo and 1%, 7%, and 10%, respectively, at 2 y.
  
  
  CONCLUSIONS
  Participants lost more fat than lean mass after consumption of all diets, with no differences in changes in body composition, abdominal fat, or hepatic fat between assigned macronutrient amounts. This trial was registered at clinicaltrials.gov as NCT00072995.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: de Souza
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Carey
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hall
authors.forename: Meryl S
authors.initials: MS
authors.lastname: LeBoff
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Loria
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Laranjo
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sacks
authors.forename: Steven R
authors.initials: SR
authors.lastname: Smith
mesh_terms: D050153:Abdominal Fat / Q000378:metabolism; D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D001823:Body Composition; D004038:Diet, Reducing; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004041:Dietary Fats / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D050152:Intra-Abdominal Fat / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D050151:Subcutaneous Fat / Q000378:metabolism; D011795:Surveys and Questionnaires; D015431:Weight Loss
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins