Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo

Brinkworth, Grant D; Noakes, Manny; Buckley, Jonathan D; Keogh, Jennifer B; Clifton, Peter M

doi:10.3945/ajcn.2008.27326

Cited by 284Diet and metabolism studiesDietary Effects on HealthNutritional Studies and Diet

Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo

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Brinkworth, Grant D, Noakes, Manny, Buckley, Jonathan D, Keogh, Jennifer B, Clifton, Peter M·2009·The American Journal of Clinical Nutrition

DOI 10.3945/ajcn.2008.27326

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Abstract

BACKGROUND: Long-term weight loss and cardiometabolic effects of a very-low-carbohydrate, high-saturated-fat diet (LC) and a high-carbohydrate, low-fat diet (LF) have not been evaluated under isocaloric conditions. OBJECTIVE: The objective was to compare an energy-controlled LC diet with an LF diet at 1 y. DESIGN: Men and women (n = 118) with abdominal obesity and at least one additional metabolic syndrome risk factor were randomly assigned to either an energy-restricted (approximately 6-7 MJ) LC diet (4%, 35%, and 61% of energy as carbohydrate, protein, and fat, respectively) or an isocaloric LF diet (46%, 24%, and 30% of energy as carbohydrate, protein, and fat, respectively) for 1 y. Weight, body composition, and cardiometabolic risk markers were assessed. RESULTS: Sixty-nine participants (59%) completed the trial: 33 in the LC group and 36 in the LF group. Both groups lost similar amounts of weight (LC: -14.5 +/- 1.7 kg; LF: -11.5 +/- 1.2 kg; P = 0.14, time x diet) and body fat (LC: -11.3 +/- 1.5 kg; LF: -9.4 +/- 1.2 kg; P = 0.30). Blood pressure, fasting glucose, insulin, insulin resistance, and C-reactive protein decreased independently of diet composition. Compared with the LF group, the LC group had greater decreases in triglycerides (-0.36 +/- 0.15 mmol/L; 95% CI: -0.67, -0.05 mmol/L; P = 0.011), increases in HDL cholesterol (0.23 +/- 0.09 mmol/L; 95% CI: 0.06, 0.40 mmol/L; P = 0.018) and LDL cholesterol (0.6 +/- 0.2 mmol/L; 95% CI: 0.2, 1.0 mmol/L; P = 0.001), and a greater but nonsignificant increase in apolipoprotein B (0.08 +/- 0.04 g/L; 95% CI: -0.004, 0.171 g/L; P = 0.17). CONCLUSIONS: Under planned isoenergetic conditions, as expected, both dietary patterns resulted in similar weight loss and changes in body composition. The LC diet may offer clinical benefits to obese persons with insulin resistance. However, the increase in LDL cholesterol with the LC diet suggests that this measure should be monitored. This trial was registered with the Australian New Zealand Clinical Trials Registry at (http://www.anzctr.org.au) as ACTR 12606000203550.

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In that subgroup analysis, body weight did not remain significant, whereas diastolic blood pressure became significantly different between low-carbohydrate and low-fat diets after excluding studies with unclear or high risk of bias.
“In addition, body weight did not remain signi fi cant, whereas DBP became signi fi cantly different between LC and LF diets after excluding studies with unclear or high risk of bias (29,30,35,39) .”
From Effects of low-carbohydrate dietsv. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as [35]
The Results report no significant difference in weight loss between the LC and LF groups (P = 0.14). Table 3 likewise reports no significant difference in diastolic blood pressure (P = 0.746). This is a single trial; our copy does not report the claimed subgroup analysis excluding studies at unclear or high risk of bias, or its purported significant DBP result. (LLM, conf=0.84)
Experimental — accuracy not yet measured
For TAG, heterogeneity dropped considerably when the study by Foster et al. (37) or Brinkworth et al. (35) was excluded, but the weighted mean difference did not change.
“However, for TAG, the heterogeneity dropped considerably when we excluded the study by Foster et al . (37) ( I 2 = 30 · 2; P = 0 · 17) or Brinkworth et al. (35) ( I 2 = 40 · 8; P = 0 · 09), but did not change the WMD.”
From Effects of low-carbohydrate dietsv. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as Brinkworth et al. (35)
A number of studies have previously reported increased LDL-cholesterol levels in subjects on LC diets.
“A number of studies have previously reported increased LDL-cholesterol levels in subjects on LC diets, recognising the concerns associated with this change in LDL-cholesterol concentration (12,14,15,35)”
From Effects of low-carbohydrate dietsv. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as [35]
In analyses excluding studies including subjects with associated metabolic disorders, weighted mean differences were similar to the primary meta-analysis for body weight, TAG, total cholesterol, HDL-cholesterol and LDL-cholesterol.
“In analyses that excluded studies including subjects with associated metabolic disorders (11,28,29,34,37,38) , the WMD was similar as in the primary meta-analysis for body weight (six studies), TAG (six studies), TC (one study), HDL-cholesterol (six studies) and LDL-cholesterol (six studies).”
From Effects of low-carbohydrate dietsv. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as [37]
For total cholesterol, HDL-cholesterol, LDL-cholesterol and diastolic blood pressure, heterogeneity decreased when the study by Brinkworth et al. (35) was excluded, but the weighted mean difference did not change.
“For TC, HDL-cholesterol, LDL-cholesterol and DBP, the heterogeneity decreased when the study by Brinkworth et al. (35) was excluded ( I 2 = 35 · 1; P > 0 · 10 for all), but WMD did not change.”
From Effects of low-carbohydrate dietsv. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as Brinkworth et al. (35)

Seven studies in the meta-analysis reported macronutrient consumption at the end of the intervention, with carbohydrate intake ranging from 9% to 40% of total energy intake.
“Seven studies in our meta-analysis reported the macronutrient consumption at the end of the intervention, where CHO intake ranged from 9 -40 % of total energy intake (27,35) .”
From Effects of low-carbohydrate dietsv. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as [35]
Loss of fat mass accounts for most of the reduction in body weight on a low-carbohydrate diet.
“In addition, our findings suggest that the loss of fat mass accounts for most of the reduction in body weight on a low-carbohydrate diet, which is consistent with other study findings (19, 21).”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [19]
Previous studies had small sample sizes or low completion rates, did not assess a typical low-carbohydrate diet for weight loss, or did not include diverse populations.
“Previous studies have examined the effects of low-carbohydrate diets on CVD risk factors, but most of these trials had small sample sizes or low completion rates, did not assess a typical low-carbohydrate diet for weight loss, or did not include diverse populations (19–24).”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [19]
Two previous studies that examined CRP levels found no difference between the diets; however, both had relatively small sample sizes and may have been underpowered.
“Two previous studies that examined CRP levels found no difference between the diets (19, 29); however, both had relatively small sample sizes and may have been underpowered.”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [19]
Brinkworth and colleagues reported a nonsignificant difference in Framingham risk score between a modified Atkins-style low-carbohydrate diet and a low-fat diet among 118 participants with abdominal obesity and other metabolic syndrome components.
“Brinkworth and colleagues (19) reported a nonsignificant difference in Framingham risk score between a modified Atkins-style low-carbohydrate diet and a low-fat diet among 118 participants with abdominal obesity and other metabolic syndrome components.”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [19]
Typical Western diet rich in fat and protein drastically reduces Bifidobacteria and butyrate-producing bacteria.
“Moreover, the quality of the diet (i.e., a typical Western diet rich in fat and protein) drastically reduces Bifidobacteria and butyrate-producing bacteria [386, 387]”
From Anxiety, depression, and the microbiome: A role for gut peptides (2018) · cites this paper as [386]

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Metabolic Effects of Weight Loss on a Very-Low-Carbohydrate Diet Compared With an Isocaloric High-Carbohydrate Diet in Abdominally Obese Subjects
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Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control
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Self-citation

Authors: Brinkworth, G. D., Noakes, M., Buckley, J. D., Keogh, J. B., & Clifton, P. M.
Affiliations: Commonwealth Scientific and Industrial Research Organisation (AU)
University of South Australia (AU)
Corresponding author: Brinkworth, Grant D
ORCID: Brinkworth, Grant D
Noakes, Manny
Buckley, Jonathan D
Keogh, Jennifer B
Clifton, Peter M
Venue: The American Journal of Clinical Nutrition
Publisher: Elsevier BV
Published: 2009-07
Volume: 90
Issue: 1
Pages: 23-32
ISSN: 0002-9165 (ISSN-L)
DOI: 10.3945/ajcn.2008.27326
OpenAlex: W2142213167
Cited by: 284
References: 48
Citations by year: 2026: 10 · 2025: 13 · 2024: 17 · 2023: 16 · 2022: 22 · 2021: 19 · 2020: 18 · 2019: 16 · 2018: 12 · 2017: 14 · 2016: 16 · 2015: 16 · 2014: 18 · 2013: 21 · 2012: 12
FWCI: 12.41
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 4982 d)
Locations: American Journal of Clinical Nutrition (publishedVersion, other-oa)
PubMed (publishedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders: National Heart Foundation of Australia
University of South Australia
Medical Research Council
National Health and Medical Research Council
Topics: Health Sciences › Medicine › Physiology › Diet and metabolism studies
Health Sciences › Medicine › Physiology › Dietary Effects on Health
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords: very low carbohydrate diet, low-fat diet, weight loss, abdominal obesity, metabolic syndrome, cardiometabolic risk, body composition, insulin resistance, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein B, C-reactive protein, blood pressure, fasting blood glucose, saturated fat, dietary fat composition
MeSH terms: Apolipoproteins B, Blood Pressure, Body Composition, Body Weight, C-Reactive Protein, Energy Intake, Female, Follow-Up Studies, Humans, Insulin, Lipids, Male, Obesity, Morbid, Patient Compliance, Surveys and Questionnaires, Weight Loss, Absorptiometry, Photon, Patient Selection, Diet, Fat-Restricted, Diet, Carbohydrate-Restricted

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Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo

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