Carbohydrate for weight and metabolic control: Where do we stand?

Department of Nutrition and Health, Nestlé Research Centre, Lausanne, Switzerland.
Nutrition (Impact Factor: 2.93). 02/2010; 26(2):141-5. DOI: 10.1016/j.nut.2009.07.002
Source: PubMed


Changes in lifestyle are considered to play an important role in the etiology of obesity and type 2 diabetes, and improvements in diet and physical activity are the first-choice treatment for these metabolic diseases. Since the dietary recommendations of almost 40 y ago that fat should be decreased and that carbohydrate should be increased, recommendations for a healthy diet, except for minor amendments, have not changed that much. It is generally considered that caloric restriction is more important than changes in the macronutrient composition of the diet for weight loss and body weight control. Although this is true, there is increasing evidence that changes in the macronutrient composition of the diet (decreasing carbohydrate and increasing unsaturated fats and/or protein) play a role that facilitates weight loss, increases insulin sensitivity and glucose tolerance, and improves cardiovascular risk factors, such as blood pressure, blood lipid profile, and inflammatory markers, often independent of weight loss. Low-carbohydrate diets, whether they be high in unsaturated fats and/or protein, are not recommended by the American Diabetes Association; however, despite this the Joslin Diabetes Center currently advocates a diet composition of approximately 40% carbohydrate, 30% fat, and 30% protein energy for overweight and obese adults with type 2 diabetes or prediabetes or those at high risk of developing type 2 diabetes. Hopefully, future studies will indicate whether diets with a more equilibrated macronutrient composition than presently recommended are more appropriate for body weight and metabolic control.

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    • "Aside from the effects of genetics, environmental variables, such as diet, have an important role in the onset and treatment of obesity [5]. "
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    ABSTRACT: Although several studies have assessed the influence of the glycemic index on body weight and blood pressure among adults, limited evidence exists for the pediatric age population. In the current study, we compared the effects of low glycemic index (LGI) diet to the healthy nutritional recommendation (HNR)-based diet on obesity and blood pressure among adolescent girls in pubertal ages. This 10-week parallel randomized clinical trial comprised of 50 overweight or obese and sexually mature girls less than 18 years of age years, who were randomly assigned to LGI or HNR-based diet. Macronutrient distribution was equivalently prescribed in both groups. Blood pressure, weight and waist circumference were measured at baseline and after intervention. Of the 50 participants, 41 subjects (include 82%) completed the study. The GI of the diet in the LGI group was 42.67 ± 0.067. A within-group analysis illustrated that in comparison to the baseline values, the body weight and body mass index (not waist circumference and blood pressure) decreased significantly after the intervention in both groups (P = 0.0001). The percent changes of the body weight status, waist circumference and blood pressure were compared between the two groups and the findings did not show any difference between the LGI diet consumers and those in the HNR group. In comparison to the HNR, LGI diet could not change the weight and blood pressure following a 10-week intervention. Further longitudinal studies with a long-term follow up should be conducted in this regard.
    Full-text · Article · Oct 2013 · Nutrition research and practice
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    • "In addition to central nervous system effects, low-carbohydrate ketogenic diets are also considered as a potential alternative to low-fat, high-carbohydrate dieting in preventing obesity and its metabolic complications [4]. Human trials have shown that the weight loss achieved on low carbohydrate diets is equivalent to caloric restriction on a high carbohydrate diet and may also confer cardiovascular benefits [5] [6] [7] [8] [9]. "
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    ABSTRACT: Low-carbohydrate ketogenic diets are commonly used as weight loss alternatives to low-fat diets, however the physiological and molecular adaptations to these diets are not completely understood. It is assumed that the metabolic phenotype of the ketogenic diet (KD) is caused by the absence of carbohydrate and high fat content, however in rodents the protein content of KD affects weight gain and ketosis. In this study we examined the role of methionine and choline in mediating the metabolic effects of KD. We have found that choline was more effective than methionine in decreasing the liver steatosis of KD-fed mice. On the other hand, methionine supplementation was more effective than choline in restoring weight gain and normalizing the expression of several fatty acid and inflammatory genes in the liver of KD-fed mice. Our results indicate that choline and methionine restriction rather than carbohydrate restriction underlies many of the metabolic effects of KD.
    Full-text · Article · Aug 2013 · Molecular Metabolism
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    • "These results should be viewed in the context of nutrition recommendations and usual dietary intake. Although the American Diabetes Association does not recommend a low-carbohydrate diet, other institutes prominent in diabetes care do advocate for carbohydrate composition of 40%, with replacement of a portion of carbohydrate with unsaturated fat or protein (39). The average carbohydrate consumption in the U.S., as collected by the 2005–2006 National Health and Nutrition Examination Survey, was ∼48% for males and 50% for females (40). "
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    ABSTRACT: OBJECTIVE Impaired insulin sensitivity increases the risk of cardiovascular disease. Although calorie restriction and weight loss increase insulin sensitivity, the effects of modifying macronutrient composition on insulin sensitivity are uncertain. The purpose of this study is to determine the effects on insulin sensitivity of a carbohydrate-rich diet (CARB; similar to the Dietary Approaches to Stop Hypertension [DASH] diet), a protein-rich diet (PROT; protein predominantly from plant sources), and an unsaturated fat-rich diet (UNSAT; predominantly monounsaturated).RESEARCH DESIGN AND METHODS This study was a randomized, controlled, three-period, crossover feeding study. The study participants were 164 individuals with pre- or stage 1 hypertension without diabetes. Diets were administered for 6 weeks each, with a washout period between diets of 2-4 weeks. Weight was held constant throughout the study. For our primary outcome, we calculated the quantitative insulin sensitivity check index (QUICKI) using the end-of-period fasting serum glucose and insulin. QUICKI is a validated measure of insulin sensitivity. The primary analyses used generalized estimating equations.RESULTSAt baseline, mean (SD) BMI was 30.2 (6.1) kg/m(2), and mean (SD) QUICKI was 0.35 (0.04). The UNSAT diet increased QUICKI by 0.005, more than the CARB diet (P = 0.04). PROT had no significant effect compared with CARB.CONCLUSIONSA diet that partially replaces carbohydrate with unsaturated fat may improve insulin sensitivity in a population at risk for cardiovascular disease. Given the well-recognized challenges of sustaining weight loss, our results suggest an alternative approach for improving insulin sensitivity.
    Full-text · Article · Dec 2012 · Diabetes care
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