Effects of low carbohydrate diet compared to low fat diet on reversing the metabolic syndrome, using NCEP ATP III criteria: a randomized clinical trial

Abstract

Introduction The purpose of this study is to compare the change in the metabolic syndrome prevalence and risk factors between participants who followed a low carbohydrate diet and those who followed a low fat diet for six months in Erbil city/ Iraqi Kurdistan. Methods Out of 289 apparently healthy obese adults who were chosen by a stratified multistage probability sampling method, 94 of them agreed to participate in the study. They were assigned to low carbohydrate and low fat diet groups. Both groups were followed up for 6 months and the data were taken at baseline, after 3 months and after 6 months of intervention. Ninety-four obese adults completed the intervention. One-way repeated measures ANOVA was used to compare differences of metabolic dependent variables between the two independent variables, the low carbohydrate and low fat diet, at baseline, after 3 months and after 6 months of intervention. Results The Participants in low carbohydrate diet group had greater decrease in the prevalence of MetS. At the baseline, according to the ATP III criteria, the prevalence of metabolic syndrome was 44.4% (24/54) in low carbohydrate diet group and 60% (24/40) in low fat diet group. The prevalence of MetS was decreased significantly to 16.7% (9/54) after 3 months and to 3.7% (2/54) after 6 months in low carbohydrate diet (p < 0.001). Moreover, the prevalence of MetS was decreased significantly to 32.5 (13/40) after 3 months and to 22.5% (9/40) after 6 months in low fat diet (p < 0.001). No statistically significant difference was found between low carbohydrate diet & low fat diet at the baseline (p-value = 0.136) and after 3 months and after 6 months of intervention. Conclusions Both low carbohydrate diet and low fat diet have significant effects on reducing the prevalence of MetS in obese adults when followed up for 6 months. Compared to low fat diet, low carbohydrate diet had greater effect in reducing the prevalence of metabolic syndrome. Both diet programs were found to be effective in improving the metabolic state of obese adults. Trial registration The trial is registered retrospectively at the US National Institutes of Health (ClinicalTrials.gov). The registration in the US National Institutes of Health was done in 23/12/2020 with the registration number: NCT04681924.

Gut microbiota regulate wheat starch‐induced metabolic disorders via control of colonic SCD1

“…Excessive fat intake has long been regarded as a major cause of metabolic diseases including obesity and type 2 diabetes (Schwartz et al., 1985), and the administration of an HFD is the most widely used experimental model in research for drug development to treat these diseases (Buettner et al., 2007). In the last decade, however, previous studies have reported that controlling other macronutrients such as carbohydrates may be more effective than reducing excessive fat intake (Ismael, 2021; Ludwig et al., 2022; Mansoor et al., 2016; Tobias et al., 2015); this shift highlights the need for investigating the metabolism and mechanisms of carbohydrates rather than fat in metabolic diseases. As with an HFD , a high‐carbohydrate diet is known to cause metabolic diseases (Antunes et al., 2020; Natividad et al., 2018).…”

“…However, a low‐fat diet has not shown excellent results in the improvement of obesity and metabolic disorders (Howard et al., 2006), and even in 2015, the U.S. Department of Agriculture proposed lifting the limit on the total amount of dietary fat intake (Mozaffarian & Ludwig, 2015). Through several meta‐analyses, low‐carbohydrate diets were shown as an effective and safe alternative intervention to a low‐fat diet for weight loss and metabolic diseases, and the necessity of evaluating guidelines for carbohydrate diets was asserted (Ismael, 2021; Ludwig et al., 2022; Mansoor et al., 2016; Tobias et al., 2015). This shift presents the need for further research on carbohydrate diets; in particular, studies on metabolic intervention via a high‐carbohydrate diet are not sufficient compared with previous studies conducted in a high‐fat diet model.…”

Improving transportability of randomized controlled trial inference using robust prediction methods

“…Most RCTs use more "pragmatic designs" that attempt to recruit from routine clinical practices or other relevant convenience sample settings; indeed, a search of the ClinicalTrials.gov database at the (US) National Library of Medicine (https://clinicaltrials.gov/) using the key words "representative sample" and "probability sample" finds only 8 registered clinical trials out of over 450,000 that could be confirmed to have recruited subjects in something reasonably approximating a probability sample from a well defined population, of which 7 have reported results. [11][12][13][14][15][16][17] As noted by Olson, 18 bias in the estimation of population causal effects from RCT arises from heterogeneity in treatment effects and systematic selection bias in the RCT with respect to the effect modifiers. Hence the basic approach revolves around accounting for differences between RCT and population effect modifiers.…”

“…We will consider the three PATT estimators given in (11) to (13), suppressing the PATT subscript to avoid cluttering notation.…”

“…Most RCTs use more “pragmatic designs” that attempt to recruit from routine clinical practices or other relevant convenience sample settings; indeed, a search of the ClinicalTrials.gov database at the (US) National Library of Medicine (https://clinicaltrials.gov/) using the key words “representative sample” and “probability sample” finds only 8 registered clinical trials out of over 450,000 that could be confirmed to have recruited subjects in something reasonably approximating a probability sample from a well defined population, of which 7 have reported results. 11–17…”