Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion The DIETFITS Randomized Clinical Trial
Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion The DIETFITS Randomized Clinical Trial
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DOI：
10.1001/jama.2018.0245
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发表时间：
2018-02-20
影响因子：
120.7
通讯作者：
King, Abby C.
中科院分区：
文献类型：
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作者：
Gardner, Christopher D.;Trepanowski, John F.;King, Abby C.
饮食调整仍然是成功减肥的关键。然而，对于一般人群来说，没有一种饮食策略始终上级其他饮食策略。以往的研究表明，基因型或胰岛素-葡萄糖动力学可能会改变饮食的影响。目的确定健康的低脂肪（HLF）饮食与健康的低碳水化合物（HLC）饮食对体重变化的影响，以及基因型模式或胰岛素分泌是否与饮食对体重减轻的影响有关。饮食干预检查与治疗成功相互作用的因素（DIETFITS）随机临床试验包括609名年龄在18至50岁之间的成年人，没有糖尿病，体重指数在28至40之间。试验入组时间为2013年1月29日至2015年4月14日;最终随访日期为2016年5月16日。参与者被随机分配到12个月的HLF或HLC饮食。本研究还测试了是否3个单核苷酸多态性多位点基因型反应模式或胰岛素分泌（INS-30;干预健康教育工作者通过22个饮食干预项目向HLF（n = 305）和HLC（n = 304）参与者提供行为矫正干预，在12个月内管理的特定小组会议。会议的重点是如何达到最低的脂肪或碳水化合物的摄入量，可以保持长期和强调饮食quality.Main结果和措施主要结果是12个月的体重变化和确定是否有显着的相互作用之间的饮食类型和基因型模式，饮食和胰岛素分泌，饮食和减肥。（平均年龄，40 [SD，7]岁; 57%的女性;平均体重指数，33 [SD，3]; 244 [40%]人具有低脂基因型; 180 [30%]人具有低碳水化合物基因型;平均基线INS-30，93 mu IU/mL），481（79%）人完成了试验。在HLF与HLC饮食中，碳水化合物的平均12个月常量营养素分布分别为48%与30%，脂肪为29%与45%，蛋白质为21%与23%。12个月时，HLF饮食组的体重变化为-5.3 kg，HLC饮食组为-6.0 kg（组间平均差异为0.7 kg [95% CI，-0.2至1.6 kg]）。在12个月的体重减轻中，没有显著的饮食-基因型模式相互作用（P = .20）或饮食-胰岛素分泌（INS-30）相互作用（P = .47）。有18个不良事件或严重不良事件，平均分布在2个饮食groups.Conclusions和相关性在这个为期12个月的减肥饮食研究中，有一个健康的低脂肪饮食与健康的低碳水化合物饮食之间的体重变化没有显着差异，既不是基因型模式，也不是基线胰岛素分泌与饮食对减肥的影响。在这两种常见的减肥饮食方法的背景下，这两种假设的诱发因素都无助于确定哪种饮食对谁更好。
IMPORTANCE Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets.OBJECTIVE To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss.DESIGN, SETTING, AND PARTICIPANTS The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015; the date of final follow-up was May 16, 2016. Participants were randomized to the 12-month HLF or HLC diet. The study also tested whether 3 single-nucleotide polymorphism multilocus genotype responsiveness patterns or insulin secretion (INS-30; blood concentration of insulin 30 minutes after a glucose challenge) were associated with weight loss.INTERVENTIONS Health educators delivered the behavior modification intervention to HLF (n = 305) and HLC (n = 304) participants via 22 diet-specific small group sessions administered over 12 months. The sessions focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality.MAIN OUTCOMES AND MEASURES Primary outcome was 12-month weight change and determination of whether there were significant interactions among diet type and genotype pattern, diet and insulin secretion, and diet and weight loss.RESULTS Among 609 participants randomized (mean age, 40 [SD, 7] years; 57% women; mean body mass index, 33 [SD, 3]; 244 [40%] had a low-fat genotype; 180 [30%] had a low-carbohydrate genotype; mean baseline INS-30, 93 mu IU/mL), 481 (79%) completed the trial. In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was -5.3 kg for the HLF diet vs -6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, -0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss. There were 18 adverse events or serious adverse events that were evenly distributed across the 2 diet groups.CONCLUSIONS AND RELEVANCE In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom.