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Unformatted text preview: n engl j med 360;9 nejm.org february 26, 2009 859 The new england journal of medicine established in 1812 february 26, 2009 vol. 360 no. 9 Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates Frank M. Sacks, M.D., George A. Bray, M.D., Vincent J. Carey, Ph.D., Steven R. Smith, M.D., Donna H. Ryan, M.D., Stephen D. Anton, Ph.D., Katherine McManus, M.S., R.D., Catherine M. Champagne, Ph.D., Louise M. Bishop, M.S., R.D., Nancy Laranjo, B.A., Meryl S. Leboff, M.D., Jennifer C. Rood, Ph.D., Lilian de Jonge, Ph.D., Frank L. Greenway, M.D., Catherine M. Loria, Ph.D., Eva Obarzanek, Ph.D., and Donald A. Williamson, Ph.D. Abstract From the Department of Nutrition, Har- vard School of Public Health (F.M.S., L.M.B.); the Channing Laboratory (F.M.S., V.J.C., N.L.) and the Endocrine Division (M.S.L.), Department of Medi- cine, Brigham and Women’s Hospital and Harvard Medical School; and the De- partment of Nutrition, Brigham and Women’s Hospital (K.M.) — all in Bos- ton; Pennington Biomedical Research Center of the Louisiana State University System, Baton Rouge (G.A.B., S.R.S., D.H.R., S.D.A., C.M.C., J.C.R., L.J., F.L.G., D.A.W.); and the National Heart, Lung, and Blood Institute, Bethesda, MD (C.M.L., E.O.). N Engl J Med 2009;360:859-73. Copyright © 2009 Massachusetts Medical Society. Background The possible advantage for weight loss of a diet that emphasizes protein, fat, or car- bohydrates has not been established, and there are few studies that extend beyond 1 year. Methods We randomly assigned 811 overweight adults to one of four diets; the targeted per- centages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. The diets consisted of similar foods and met guidelines for cardiovascular health. The partici- pants were offered group and individual instructional sessions for 2 years. The pri- mary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content. Results At 6 months, participants assigned to each diet had lost an average of 6 kg, which represented 7% of their initial weight; they began to regain weight after 12 months. By 2 years, weight loss remained similar in those who were assigned to a diet with 15% protein and those assigned to a diet with 25% protein (3.0 and 3.6 kg, respec- tively); in those assigned to a diet with 20% fat and those assigned to a diet with 40% fat (3.3 kg for both groups); and in those assigned to a diet with 65% carbo- hydrates and those assigned to a diet with 35% carbohydrates (2.9 and 3.4 kg, re- spectively) (P>0.20 for all comparisons). Among the 80% of participants who com- pleted the trial, the average weight loss was 4 kg; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. Satiety, hunger, satisfaction a reduction of at least 10% of their initial body weight....
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