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Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial
Open accessAbstract
Background Weight loss reduces body fat and lean mass, but whether these changes are influenced by macronutrient composition of the diet is unclear.Objective We determined whether energy-reduced diets that emphasize fat, protein, or carbohydrate differentially reduce total, visceral, or hepatic fat or preserve lean mass.Design In a subset of participants in a randomized trial of 4 weight-loss diets, body fat and lean mass (n = 424; by using dual-energy X-ray absorptiometry) and abdominal and hepatic fat (n = 165; by using computed tomography) were measured after 6 mo and 2 y. Changes from baseline were compared between assigned amounts of protein (25% compared with 15%) and fat (40% compared with 20%) and across 4 carbohydrate amounts (35% through 65%).Results At 6 mo, participants lost a mean (±SEM) of 4.2 ± 0.3 kg (12.4%) fat and 2.1 ± 0.3 kg (3.5%) lean mass (both P < 0.0001 compared with baseline values), with no differences between 25% and 15% protein (P ≥ 0.10), 40% and 20% fat (P ≥ 0.34), or 65% and 35% carbohydrate (P ≥ 0.27). Participants lost 2.3 ± 0.2 kg (13.8%) abdominal fat: 1.5 ± 0.2 kg (13.6%) subcutaneous fat and 0.9 ± 0.1 kg (16.1%) visceral fat (all P < 0.0001 compared with baseline values), with no differences between the diets (P ≥ 0.29). Women lost more visceral fat than did men relative to total-body fat loss. Participants regained ~40% of these losses by 2 y, with no differences between diets (P ≥ 0.23). Weight loss reduced hepatic fat, but there were no differences between groups (P ≥ 0.28). Dietary goals were not fully met; self-reported contrasts were closer to 2% protein, 8% fat, and 14% carbohydrate at 6 mo and 1%, 7%, and 10%, respectively, at 2 y.Conclusion Participants lost more fat than lean mass after consumption of all diets, with no differences in changes in body composition, abdominal fat, or hepatic fat between assigned macronutrient amounts. This trial was registered at clinicaltrials.gov as NCT00072995.
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“Despite their capability to facilitate statistically significant weight loss [132], VLFDs lack significant fat loss advantages compared to higher-fat diets, particularly in the long-term [133–135].”
From International Society of Sports Nutrition position stand: diets for body weight reduction (2026) · cites this paper as [134]
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“Research suggests that few people adhere to strict macronutrient targets 83”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [83]
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Metadata
- Authors
- de Souza, R. J., Bray, G. A., Carey, V. J., Hall, K. D., LeBoff, M. S., Loria, C. M., Laranjo, N. M., Sacks, F. M., & Smith, S. R.
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 95
- Issue
- 3
- Pages
- 614-625
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC3278241
- OpenAlex
- W2102602599
- Cited by
- 192
- References
- 60
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 8 · 2023: 12 · 2022: 12 · 2021: 11 · 2020: 12 · 2019: 14 · 2018: 12 · 2017: 20 · 2016: 18 · 2015: 17 · 2014: 15 · 2013: 17 · 2012: 11
- FWCI
- 12.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL073286, U01HL073286)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK072476)
- National Center for Research Resources (RR02635, M01RR002635)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
- Keywords
- weight loss, macronutrient composition, high-protein diet, high-fat diet, high-carbohydrate diet, visceral adipose tissue, liver fat, fat mass, lean body mass, abdominal fat, weight regain, POUNDS Lost trial, hypocaloric diet, dietary adherence, obesity treatment
- MeSH terms
- Adult, Aged, Body Composition, Energy Intake, Diet, Reducing, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Female, Follow-Up Studies, Humans, Interviews as Topic, Male, Middle Aged, Patient Compliance, Surveys and Questionnaires, Weight Loss, Absorptiometry, Photon, Subcutaneous Fat, Intra-Abdominal Fat, Abdominal Fat
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