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A randomized study of dietary composition during weight-loss maintenance: Rationale, study design, intervention, and assessment.

Contemporary clinical trials
February 1, 2018
Cara B Ebbeling et al. (16 authors)
Clinical Trial ProtocolJournal ArticleResearch Support, N.I.H., ExtramuralHuman StudyClinical
Study Details

Study Goal

The researchers aimed to evaluate the effects of three test diets with varying carbohydrate-to-fat ratios on weight-loss maintenance and energy expenditure.

Results Summary

The study compared high-carbohydrate, moderate-carbohydrate, and low-carbohydrate diets during weight-loss maintenance, measuring energy expenditure and weight change during an ad libitum feeding phase as a proxy for hunger. Results focused on metabolic outcomes but did not explicitly report comparative efficacy in weight maintenance.

Population

164 participants aged 18–65 years with overweight or obesity who achieved initial weight loss of 12±2% of baseline body weight.

Effective Dosage

Diets provided 20% protein, with varying carbohydrate (20–60%) and fat (20–60%) ratios.

Duration

20-week test phase followed by a 2-week ad libitum feeding phase.

Interactions

None mentioned

Extracted Claims (19)
InterventionDirectionEndpointPopulationDosageImpactClaim #
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat)
neutral
body weight
164 participants aged 18 to 65 years
-
assessed the effect
#1
moderate-carbohydrate diet (40% carbohydrate, 40% fat)
neutral
body weight
164 participants aged 18 to 65 years
-
assessed the effect
#2
low-carbohydrate diet (20% carbohydrate, 60% fat)
neutral
body weight
164 participants aged 18 to 65 years
-
assessed the effect
#3
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat)
neutral
total energy expenditure
164 participants aged 18 to 65 years
-
evaluated
#4
moderate-carbohydrate diet (40% carbohydrate, 40% fat)
neutral
total energy expenditure
164 participants aged 18 to 65 years
-
evaluated
#5
low-carbohydrate diet (20% carbohydrate, 60% fat)
neutral
total energy expenditure
164 participants aged 18 to 65 years
-
evaluated
#6
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat)
neutral
resting energy expenditure
164 participants aged 18 to 65 years
-
assessed
#7
moderate-carbohydrate diet (40% carbohydrate, 40% fat)
neutral
resting energy expenditure
164 participants aged 18 to 65 years
-
assessed
#8
low-carbohydrate diet (20% carbohydrate, 60% fat)
neutral
resting energy expenditure
164 participants aged 18 to 65 years
-
assessed
#9
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat)
neutral
physical activity
164 participants aged 18 to 65 years
-
assessed
#10
moderate-carbohydrate diet (40% carbohydrate, 40% fat)
neutral
physical activity
164 participants aged 18 to 65 years
-
assessed
#11
low-carbohydrate diet (20% carbohydrate, 60% fat)
neutral
physical activity
164 participants aged 18 to 65 years
-
assessed
#12
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat)
neutral
chronic disease risk factors
164 participants aged 18 to 65 years
-
assessed
#13
moderate-carbohydrate diet (40% carbohydrate, 40% fat)
neutral
chronic disease risk factors
164 participants aged 18 to 65 years
-
assessed
#14
low-carbohydrate diet (20% carbohydrate, 60% fat)
neutral
chronic disease risk factors
164 participants aged 18 to 65 years
-
assessed
#15
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat)
neutral
metabolism
164 participants aged 18 to 65 years
-
influence
#16
moderate-carbohydrate diet (40% carbohydrate, 40% fat)
neutral
metabolism
164 participants aged 18 to 65 years
-
influence
#17
low-carbohydrate diet (20% carbohydrate, 60% fat)
neutral
metabolism
164 participants aged 18 to 65 years
-
influence
#18
standard run-in diet
decrease
body weight
164 participants aged 18 to 65 years
12±2% of baseline body weight
weight loss corresponding to
#19
Abstract

BACKGROUND: While many people with overweight or obesity can lose weight temporarily, most have difficulty maintaining weight loss over the long term. Studies of dietary composition typically focus on weight loss, rather than weight-loss maintenance, and rely on nutrition education and dietary counseling, rather than controlled feeding protocols. Variation in initial weight loss and insufficient differentiation among treatments confound interpretation of results and compromise conclusions regarding the weight-independent effects of dietary composition. The aim of the present study was to evaluate three test diets differing in carbohydrate-to-fat ratio during weight-loss maintenance. DESIGN AND DIETARY INTERVENTIONS: Following weight loss corresponding to 12±2% of baseline body weight on a standard run-in diet, 164 participants aged 18 to 65years were randomly assigned to one of three test diets for weight-loss maintenance through 20weeks (test phase). We fed them high-carbohydrate (60% of energy from carbohydrate, 20% fat), moderate-carbohydrate (40% carbohydrate, 40% fat), and low-carbohydrate (20% carbohydrate, 60% fat) diets, controlled for protein content (20% of energy). During a 2-week ad libitum feeding phase following the test phase, we assessed the effect of the test diets on body weight. OUTCOMES: The primary outcome was total energy expenditure, assessed by doubly-labeled water methodology. Secondary outcomes included resting energy expenditure and physical activity, chronic disease risk factors, and variables to inform an understanding of physiological mechanisms by which dietary carbohydrate-to-fat ratio might influence metabolism. Weight change during the ad libitum feeding phase was conceptualized as a proxy measure of hunger.

Medical Subject Headings (MeSH)
AdolescentAdultAge FactorsAgedBlood PressureBody Weights and MeasuresChronic DiseaseDiet, Carbohydrate-RestrictedDietary CarbohydratesDietary FatsEnergy MetabolismExerciseFemaleHumansHungerInflammation MediatorsLipidsMaleMiddle AgedObesityOverweightRacial GroupsResearch DesignRisk FactorsSex FactorsWeight LossYoung AdultRandomized Controlled Trials as Topic
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations14
Citations/Year2.0
Relative Citation Ratio0.64
NIH Percentile34.7%
Research Impact Scores
APT Score0.50
Weight Score2.15
Normalized Score0.67
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