Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control

Abstract

Background and aim Very low carbohydrate ad libitum diets have been shown to enhance weight loss without increasing cardiometabolic risk factors but no kilojoule-controlled trials have been conducted relative to no intervention. The aim of this study was to compare the changes in weight and other cardiovascular risk factors in 3 isocaloric energy-restricted diets to no-intervention control after 1 year. Methods and results One hundred and thirteen subjects (age 47 ± 10 years, BMI 32 ± 6 kg/m 2 with one additional cardiovascular risk factor) were randomly allocated to one of three isocaloric diets (VLC-very low carbohydrate, 60% fat, 4% carbohydrate, n = 30; VLF-very low fat, 10% fat, n = 30; HUF-high unsaturated fat, 30% fat, n = 30) with intensive support for 3 months followed by minimal support for 12 months compared to a control group (no intervention, n = 23). The estimated weight change was −3.0 ± 0.2 kg for VLC, −2.0 ± 0.1 kg for VLF, −3.7 ± 0.01 kg for HUF and 0.8 ± 0.5 kg for controls ( P = 0.065). After correcting for baseline values, decreases in body weight and diastolic blood pressure in the diet groups (−2.9 ± 5.2) were significantly different to the increase in the control group (0.8 ± 5.0) ( P < 0.05). No differences in cardiovascular risk factors were observed between the diet groups. Conclusion Significant cardiometabolic risk factor reduction was observed equally with VLC, VLF and HUF diets after 15 months, compared to an exacerbation of risk factors in the control group. At a modest level of adherence, 3 months of intensive support on these dietary patterns confer an improvement in cardiometabolic profile compared to no dietary intervention after 15 months.