Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.
Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.
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DOI：
10.1056/nejmoa0804748
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发表时间：
2009-02-26
期刊：
影响因子：
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通讯作者：
Williamson DA
中科院分区：
文献类型：
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作者：
Sacks FM;Bray GA;Carey VJ;Smith SR;Ryan DH;Anton SD;McManus K;Champagne CM;Bishop LM;Laranjo N;Leboff MS;Rood JC;de Jonge L;Greenway FL;Loria CM;Obarzanek E;Williamson DA
强调蛋白质，脂肪或碳水化合物的饮食对减肥的可能优势尚未确定，并且很少有研究超过1年。我们将811名超重的成年人随机分配到四种饮食中的一种;四种饮食中来自脂肪，蛋白质和碳水化合物的能量的目标百分比分别为20，15和65%; 20，25和55%; 40，15和45%; 40，25和35%。这些饮食由类似的食物组成，符合心血管健康指南。参与者被提供为期2年的团体和个人教学课程。主要结局是2年后低脂肪与高脂肪、平均蛋白质与高蛋白质的2 × 2析因比较以及最高和最低碳水化合物含量的比较中体重的变化。在6个月时，被分配到每种饮食的参与者平均减轻了6公斤，这代表了他们最初体重的7%;他们在12个月后开始恢复体重。到2年时，那些被分配到15%蛋白质饮食的人和那些被分配到25%蛋白质饮食的人的体重减轻保持相似（分别为3.0和3.6 kg）;在分配至含20%脂肪的饮食和分配至含40%脂肪的饮食的受试者中（两组均为3.3 kg）;分配至含65%碳水化合物饮食组和分配至含35%碳水化合物饮食组的受试者（分别为2.9和3.4 kg）（所有比较P>0.20）。在80%完成试验的参与者中，平均体重减轻4公斤; 14 - 15%的参与者体重至少减轻了10%。对于所有饮食，饱腹感、饥饿感、对饮食的满意度和参加小组会议的情况都是相似的;参加小组会议与体重减轻密切相关（每次参加0.2公斤）。饮食改善了与脂质相关的风险因素和空腹胰岛素水平。降低卡路里的饮食导致临床上有意义的体重减轻，无论他们强调哪些宏量营养素。
The possible advantage for weight loss of a diet that emphasizes protein, fat, or carbohydrates has not been established, and there are few studies that extend beyond 1 year. We randomly assigned 811 overweight adults to one of four diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. The diets consisted of similar foods and met guidelines for cardiovascular health. The participants were offered group and individual instructional sessions for 2 years. The primary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content. At 6 months, participants assigned to each diet had lost an average of 6 kg, which represented 7% of their initial weight; they began to regain weight after 12 months. By 2 years, weight loss remained similar in those who were assigned to a diet with 15% protein and those assigned to a diet with 25% protein (3.0 and 3.6 kg, respectively); in those assigned to a diet with 20% fat and those assigned to a diet with 40% fat (3.3 kg for both groups); and in those assigned to a diet with 65% carbohydrates and those assigned to a diet with 35% carbohydrates (2.9 and 3.4 kg, respectively) (P>0.20 for all comparisons). Among the 80% of participants who completed the trial, the average weight loss was 4 kg; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. Satiety, hunger, satisfaction with the diet, and attendance at group sessions were similar for all diets; attendance was strongly associated with weight loss (0.2 kg per session attended). The diets improved lipid-related risk factors and fasting insulin levels. Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.