Further, contrary to the common notion, a high intake of carbohydrates was found to increase the levels of triacylglycerols, total cholesterol, and low-density lipoprotein (LDL) cholesterol and decrease the level of high-density lipoprotein (HDL) choles terol. Elevated levels of triacylglycerols and low levels of HDL were associated with hyperinsulinemia. Also, an elevated triacyl glycerol level, particularly a high ratio of triacylglycerols to HDL, is an important predictor of heart attack. 2 Recent studies have quite evidently shown that the ketogenic diet is a natural therapy for obesity and obesity-associated dis eases. However, there are very few studies that have addressed the long-term influence of a ketogenic diet in modifying various obesity-associated diseases. Hence, the purpose of this study was to investigate the long-term effect of a ketogenic diet on the activation and modification of heart disease risk factors in obese patients.