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ORIGINAL RESEARCH COMMUNICATION |
1 From the Division of Endocrinology, Department of Medicine, Children's Hospital, Boston, MA
Background: The optimal nutritional approach for the prevention of cardiovascular disease among obese persons remains a topic of intense controversy. Available approaches range from conventional low-fat to very-low-carbohydrate diets.
Objective: The aim of this pilot study was to evaluate the efficacy of an ad libitum low-glycemic load diet, without strict limitation on carbohydrate intake, as an alternative to a conventional low-fat diet.
Design: A randomized controlled trial compared 2 dietary treatments in obese young adults (n = 23) over 12 mo. The experimental treatment emphasized ad libitum consumption of low-glycemic-index foods, with 45–50% of energy from carbohydrates and 30–35% from fat. The conventional treatment was restricted in energy (250–500 kcal/d deficit) and fat (<30% of energy), with 55–60% of energy from carbohydrate. We compared changes in study outcomes by repeated-measures analysis of log-transformed data and expressed the results as mean percentage change.
Results: Body weight decreased significantly over a 6-mo intensive intervention in both the experimental and conventional diet groups (–8.4% and –7.8%, respectively) and remained below baseline at 12 mo (–7.8% and –6.1%, respectively). The experimental diet group showed a significantly greater mean decline in plasma triacylglycerols than did the conventional diet group (–37.2% and –19.1%, respectively; P = 0.005). Mean plasminogen activator inhibitor 1 concentrations decreased (–39.0%) in the experimental diet group but increased (33.1%) in the conventional diet group (P = 0.004). Changes in cholesterol concentrations, blood pressure, and insulin sensitivity did not differ significantly between the groups.
Conclusion: An ad libitum low-glycemic load diet may be more efficacious than a conventional, energy-restricted, low-fat diet in reducing cardiovascular disease risk.
Key Words: Obesity • glycemic index • glycemic load • dietary composition • weight-reducing diet • cholesterol • triacylglycerol • plasminogen activator inhibitor 1 • PAI-1 • young adults
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