Testing the carbohydrate-insulin model of obesity in a 5-month feeding study: the perils of post-hoc participant exclusions
Open accessAbstract
A large feeding study reported that total energy expenditure (TEE) was greater on a low- versus high-carbohydrate diet, supporting the carbohydrate-insulin model of obesity. Recently, the validity of this finding was challenged in a post-hoc analysis excluding participants with putative non-adherence to the study diets. Here, we show why that analysis, based on a post-randomization variable linked to the outcome, introduced severe confounding bias. With control for confounding, the diet effect on TEE remained strong in a reanalysis. Together with sensitivity analyses demonstrating robustness to plausible levels of non-adherence, these data provide experimental support for a potentially novel metabolic effect of macronutrients that might inform the design of more effective obesity treatment.
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Data from a large 5-month study demonstrating increased energy expenditure when consuming a low-carbohydrate diet during weight-loss maintenance appear robust.
“data from a large 5-mo study demonstrating increased energy expenditure when consuming a low-carbohydrate diet during weight-loss maintenance appear robust (106, 153, 154).”
From The carbohydrate-insulin model: A physiological perspective on the obesity pandemic (2021) · cites this paper as [153]
Other analyses have reported greater energy expenditure from low-carbohydrate diets.
“Other analyses have reported greater EE from low-carbohydrate diets [62, 63].”
From Benefits of low carbohydrate diets: a settled question or still controversial? (2021) · cites this paper as [63]
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References 9 · Cited by 10
Research works printed but not linked: 1
- [10]Piantadosi S Random error and bias (Chpt 6) in Clinical trials: a methodological perspective, 3rd ed, 2017 John Wiley & Sons, Inc., Hoboken, NJ
- Authors
- Ludwig, D. S., Greco, K. F., Ma, C., & Ebbeling, C. B.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Ludwig, David S.
- Venue
- European Journal of Clinical Nutrition
- Published
- 2020-05-20
- Volume
- 74
- Issue
- 7
- Pages
- 1109-1112
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- PMC
- PMC7340622
- OpenAlex
- W3026283308
- Cited by
- 10
- References
- 9
- Citations by year
- 2023: 1 · 2022: 2 · 2021: 4 · 2020: 3
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Clinical Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute of Diabetes and Digestive and Kidney Diseases (K24DK082730)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- total energy expenditure, low-carbohydrate diet, high-carbohydrate diet, dietary adherence, confounding, macronutrient metabolism, obesity treatment, sensitivity analysis
- MeSH terms
- Blood Glucose, Diet, Dietary Carbohydrates, Energy Metabolism, Humans, Insulin, Obesity
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