Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost. This finding should be interpreted with caution, given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study. Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.

Participants on a low-carbohydrate diet had more favorable overall outcomes at 1 year than did those on a conventional diet. Weight loss was similar between groups, but effects on atherogenic dyslipidemia and glycemic control were still more favorable with a low-carbohydrate diet after adjustment for differences in weight loss.

No abstract

Background-PPAR-␥ agonists improve insulin sensitivity and glycemic control in type 2 diabetes and may reduce atherosclerosis progression. Thus, PPAR-␥ agonists may be an effective therapy for metabolic syndrome. However, the full spectrum of potentially antiatherogenic mechanisms of PPAR-␥ agonists have not been fully tested in nondiabetic patients with metabolic syndrome. Methods and Results-We performed a prospective, double-blinded, placebo-controlled study of 60 nondiabetic subjects with low high-density lipoprotein cholesterol (HDL-C) level and metabolic syndrome to rosiglitazone 8 mg daily or placebo for 12 weeks. We found no significant effect of rosiglitazone on HDL-C (ϩ5.5% versus ϩ5.8%, Pϭ0.89), and an increase in total cholesterol (ϩ8% versus Ϫ1%; Pϭ0.03). Nevertheless, rosiglitazone significantly increased adiponectin (ϩ168% versus ϩ25%; PϽ0.001), and lowered resistin (Ϫ6% versus ϩ4%; Pϭ0.009), C-reactive protein (Ϫ32% versus ϩ36%, Pϭ0.002), interleukin (IL)-6 (Ϫ22% versus ϩ4%, PϽ0.001), and soluble tumor-necrosis factor-␣ receptor-2 (Ϫ5% versus ϩ7%, PϽ0.001). Conclusions-These findings suggest that rosiglitazone, presumably through its PPAR-␥ agonist properties, has direct effects on inflammatory markers and adipokines in the absence of favorable lipid effects. These findings may help explain the mechanism underlying the possible antiatherosclerotic effects of rosiglitazone.