Background
Methods
Study design and participants
Diet interventions
Outcomes and follow-up
Statistical analysis
Results
Baseline characteristic
Characteristic | NC diet (n = 74) | LC diet (n = 76) | CR diet (n = 72) | LC + CR diet (n = 76) |
---|---|---|---|---|
Female, no. (%) | 48 (64.9) | 53 (69.7) | 52 (72.2) | 52 (68.4) |
Age, years | 35.1 (8.2) | 34.2 (7.8) | 33.6 (6.4) | 33.2 (7.0) |
High school education, no. (%) | 26 (35.1) | 24 (31.6) | 28 (38.9) | 30 (39.5) |
Current cigarette smoking, no. (%) | 8 (10.8) | 6 (7.9) | 8 (11.1) | 7 (9.2) |
Current alcohol drinking, no. (%) | 13 (17.6) | 15 (19.7) | 10 (13.9) | 11 (14.5) |
Total energy intake, kcal/day | 1841.7 (436.4) | 1792.9 (521.6) | 1720.0 (449.4) | 1783.3 (552.0) |
Carbohydrate intake, % | 50.3 (6.5) | 48.1 (5.0) | 50.6 (6.2) | 51.7 (10.3) |
Protein intake, % | 21.3 (4.5) | 21.6 (2.9) | 18.2 (3.4) | 18.2 (4.6) |
Fat intake, % | 28.3 (2.3) | 30.3 (6.7) | 30.4 (3.6) | 31.0 (4.7) |
Weight, kg | 79.6 (14.0) | 80.2 (14.1) | 80.1 (13.1) | 83.6 (18.9) |
BMI, kg/m2 | 29.9 (3.9) | 30.2 (3.8) | 30.3 (3.4) | 31.0 (4.7) |
Waist circumference, cm | 94.2 (10.3) | 93.9 (10.0) | 95.0 (9.3) | 95.6 (13.7) |
WHR | 0.89 (0.06) | 0.89 (0.05) | 0.90 (0.06) | 0.89 (0.07) |
Heart rate, beats/min | 77.0 (8.0) | 78.7 (8.8) | 76.8 (11.2) | 76.8 (8.6) |
Blood pressure, mmHg | ||||
Systolic | 118.4 (12.5) | 114.9 (10.8) | 115.0 (10.8) | 115.5 (12.2) |
Diastolic | 75 (16.6) | 76.7 (9.2) | 79.54 (7.9) | 77.9 (7.5) |
Plasma glucose, mg/dL | 94.3 (9.3) | 92.0 (9.8) | 93.9 (9.1) | 93.8 (8.3) |
HOMA-IR | 3.6 (2.4) | 3.5 (2.6) | 3.2 (3.8) | 3.7 (2.4) |
Serum triglycerides, mg/dL | 148.8 (83.1) | 135.2 (82.5) | 130.5 (94.0) | 159.8 (123.3) |
Serum total cholesterol, mg/dL | 196.2 (36.3) | 190.6 (38.4) | 198.3 (38.2) | 192.3 (36.8) |
HDL, mg/dL | 47.2 (11.3) | 48.4 (13.2) | 48.2 (9.6) | 45.5 (9.8) |
LDL, mg/dL | 120.3 (31.4) | 115.0 (33.5) | 123.5 (31.6) | 115.9 (26.8) |
ALT, IU/L | 27.5 (22.9) | 25.2 (16.2) | 27.5 (18.7) | 29.1 (21.2) |
AST, IU/L | 21.7 (10.2) | 20.1 (7.8) | 20.7 (8.6) | 20.9 (8.4) |
Uric acid, mg/dl | 6.7 (1.5) | 6.5 (1.6) | 6.7 (1.6) | 6.8 (1.9) |
Body fat, % | 34.4 (4.5) | 34.6 (5.1) | 35.4 (4.3) | 34.8 (4.1) |
Visceral fat area, cm2 | 111.5 (40.3) | 104.7 (34.5) | 10.7 (31.9) | 103.9 (45.3) |
Body muscle rate, % | 59.6 (8.2) | 60.7 (8.2) | 58.3 (11.5) | 61.4 (7.2) |
Dietary intake and adherence
Characteristic | Changes (95% CIs) | P values | |||||||
---|---|---|---|---|---|---|---|---|---|
NC diet (n = 74) | LC diet (n = 76) | CR diet (n = 72) | LC + CR diet (n = 76) | LC diet vs NC diet | LC + CR diet vs CR diet | CR diet vs NC diet | LC + CR diet vs LC diet | LC diet vs CR diet | |
Energy intake, kcal | |||||||||
Week 4 | 1654.3 (1555.8 to 1752.8) | 1519.1 (1471.0 to 1567.1) | 1217.2 (1142.9 to 1291.6) | 1281.9 (1231.4 to 1332.4) | 0.005 | 0.179 | < 0.001 | < 0.001 | < 0.001 |
Week 8 | 1653.4 (1551.2 to 1755.7) | 1510.3 (1463.8 to 1556.8) | 1218.7 (1141.6 to 1295.8) | 1283.0 (1235.2 to 1330.9) | 0.004 | 0.187 | < 0.001 | < 0.001 | < 0.001 |
Week 12 | 1639.0 (1535.9 to 1742.1) | 1503.6 (1459 to 1548.2) | 1217.1 (1140.0 to 1294.2) | 1278.0 (1229.9 to 1326.2) | 0.006 | 0.211 | < 0.001 | < 0.001 | < 0.001 |
Carbohydrate intake, g | |||||||||
Week 4 | 203.3 (187.1 to 219.5) | 63.1 (60.6 to 65.6) | 145.8 (133.9 to 157.8) | 57.6 (53.3 to 61.9) | < 0.001 | < 0.001 | < 0.001 | 0.4 | < 0.001 |
Week 8 | 199.8 (182.8 to 216.9) | 63.7 (60.8 to 66.6) | 145.6 (133.1 to 158) | 58.5 (54.1 to 62.9) | < 0.001 | < 0.001 | < 0.001 | 0.475 | < 0.001 |
Week 12 | 202.8 (185.6 to 220) | 62.8 (60.4 to 65.2) | 146.7 (134.1 to 159.2) | 57.9 (53.7 to 62.1) | < 0.001 | < 0.001 | < 0.001 | 0.448 | < 0.001 |
Carbohydrate intake, % | |||||||||
Week 4 | 48.8 (46.9 to 50.8) | 16.7 (16.1 to 17.3) | 47.6 (45.7 to 49.6) | 17.9 (17.1 to 18.6) | < 0.001 | < 0.001 | 0.235 | 0.212 | < 0.001 |
Week 8 | 48.6 (46.7 to 50.6) | 16.7 (16.2 to 17.2) | 47.8 (45.8 to 49.9) | 17.9 (17.2 to 18.7) | < 0.001 | < 0.001 | 0.436 | 0.179 | < 0.001 |
Week 12 | 48.3 (46.6 to 50.1) | 17.1 (16.1 to 18.1) | 47.5 (45.5 to 49.6) | 18.2 (17.4 to 19.0) | < 0.001 | < 0.001 | 0.445 | 0.25 | < 0.001 |
Protein intake, g | |||||||||
Week 4 | 36.8 (33.6 to 40) | 55.4 (53 to 57.8) | 27.1 (24.6 to 29.7) | 47.4 (45 to 49.8) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Week 8 | 35.9 (33 to 38.8) | 55.8 (53.3 to 58.3) | 27.7 (24.9 to 30.5) | 47 (44.7 to 49.2) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Week 12 | 36.4 (33.5 to 39.3) | 55.6 (53.1 to 58.1) | 27.7 (24.8 to 30.6) | 47.3 (45.1 to 49.5) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Protein intake, % | |||||||||
Week 4 | 20.0 (18.8 to 21.2) | 32.9 (31.9 to 33.8) | 20.2 (18.4 to 21.9) | 33.1 (32.4 to 33.8) | < 0.001 | < 0.001 | 0.835 | 0.746 | < 0.001 |
Week 8 | 19.8 (18.8 to 20.9) | 33.1 (32.2 to 34.0) | 20.6 (18.5 to 22.6) | 33.1 (32.4 to 33.8) | < 0.001 | < 0.001 | 0.423 | 0.981 | < 0.001 |
Week 12 | 19.7 (18.7 to 20.7) | 33.5 (32.2 to 34.7) | 20.6 (18.7 to 22.5) | 33.0 (32.3 to 33.7) | < 0.001 | < 0.001 | 0.331 | 0.569 | < 0.001 |
Fat intake, g | |||||||||
Week 4 | 59.9 (56.0 to 63.9) | 84.0 (80.1 to 87.9) | 48.3 (45.6 to 50.9) | 67.6 (65.4 to 69.9) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Week 8 | 60.1 (56.4 to 63.8) | 82.8 (79.6 to 86.0) | 48.1 (45.5 to 50.6) | 67.7 (65.5 to 69.9) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Week 12 | 59.8 (56.3 to 63.3) | 82.8 (80.1 to 85.6) | 48.2 (45.7 to 50.8) | 67.3 (65.1 to 69.5) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Fat intake, % | |||||||||
Week 4 | 32.9 (31.3 to 34.4) | 49.7 (48.6 to 50.7) | 36.2 (34.6 to 37.7) | 47.7 (46.9 to 48.5) | < 0.001 | < 0.001 | < 0.001 | 0.019 | < 0.001 |
Week 8 | 33.0 (31.5 to 34.6) | 49.3 (48.4 to 50.3) | 36.0 (34.6 to 37.4) | 47.7 (46.9 to 48.4) | < 0.001 | < 0.001 | < 0.001 | 0.031 | < 0.001 |
Week 12 | 33.2 (31.9 to 34.6) | 49.7 (48.5 to 50.9) | 36.2 (34.8 to 37.6) | 47.5 (46.8 to 48.2) | < 0.001 | < 0.001 | < 0.001 | 0.006 | < 0.001 |
Weight loss and body composition
Outcomes | Changes (95% CIs) | P Values | |||||||
---|---|---|---|---|---|---|---|---|---|
NC diet (n = 74) | LC diet (n = 76) | CR diet (n = 72) | LC + CR diet (n = 76) | LC diet vs NC diet | LC diet vs CR diet | LC + CR diet vs LC diet | LC + CR diet vs CR diet | Group differences | |
BMI, kg/m2 | − 0.6 (− 0.8 to − 0.3) | − 2.3 (− 2.6 to − 2.1) | − 1.3 (− 1.5 to − 1.0) | − 2.9 (− 3.2 to − 2.6) | < 0.001 | < 0.001 | 0.001 | < 0.001 | < 0.001 |
Weight, kg | − 1.5 (− 2.2 to − 0.8) | − 5.9 (− 6.6 to − 5.2) | − 3.3 (− 4.0 to − 2.6) | − 7.8 (− 8.5 to − 7.2) | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Waist circumference, cm | − 1.7 (− 2.4 to − 0.9) | − 5.5 (− 6.2 to − 4.7) | − 3.3 (− 4.0 to − 2.5) | − 6.9 (− 7.6 to − 6.1) | < 0.001 | < 0.001 | 0.009 | < 0.001 | < 0.001 |
WHR ratio | − 0.01 (− 0.01 to 0.00) | − 0.03 (− 0.03 to − 0.02) | − 0.02 (− 0.03 to − 0.01) | − 0.03 (− 0.03 to − 0.02) | < 0.001 | 0.155 | 0.358 | 0.020 | < 0.001 |
Body fat, % | − 0.6 (− 1.1 to − 0.1) | − 2.5 (− 3.0 to − 2.0) | − 1.5 (− 2.0 to − 1.0) | − 3.0 (− 3.5 to − 2.6) | < 0.001 | 0.004 | 0.110 | < 0.001 | < 0.001 |
Metabolic risk factors
Outcome | Between-group differences from baseline to week 12 | P value of group differences | |||||
---|---|---|---|---|---|---|---|
LC diet vs NC diet | CR diet vs NC diet | LC + CR diet vs NC diet | |||||
Changes (95% CIs) | P value | Changes (95% CIs) | P value | Changes (95% CIs) | P value | ||
Plasma glucose, mg/dL | |||||||
Week 4 | − 0.7 (− 3.4 to 2.1) | 0.635 | − 2.0 (− 4.8 to 0.9) | 0.172 | − 3.7 (− 6.5 to − 0.9) | 0.01 | 0.049 |
Week 8 | − 0.5 (− 3.2 to 2.2) | 0.732 | − 1.4 (− 4.1 to 1.4) | 0.327 | − 3.0 (− 5.7 to − 0.3) | 0.028 | 0.128 |
Week 12 | − 0.7 (− 3.8 to 2.5) | 0.679 | − 2.5 (− 5.8 to 0.7) | 0.119 | − 0.6 (− 3.8 to 2.5) | 0.702 | 0.436 |
HOMA-IR | |||||||
Week 4 | − 0.9 (− 1.8 to − 0.1) | 0.03 | − 0.4 (− 1.3 to 0.4) | 0.321 | − 1.3 (− 2.1 to − 0.4) | 0.003 | 0.016 |
Week 8 | − 0.5 (− 1.4 to 0.3) | 0.219 | 0.4 (− 0.5 to 1.3) | 0.354 | − 0.8 (− 1.7 to 0.1) | 0.065 | 0.028 |
Week 12 | − 0.4 (− 1.3 to 0.4) | 0.277 | 0.2 (− 0.6 to 1.0) | 0.587 | − 0.6 (− 1.4 to 0.2) | 0.174 | 0.187 |
Serum triglycerides, mg/dL | |||||||
Week 4 | 10.3 (− 20.8 to 41.5) | 0.515 | 19.8 (− 11.8 to 51.4) | 0.219 | − 39.4 (− 70.5 to − 8.2) | 0.013 | 0.001 |
Week 8 | − 8.1 (− 32.6 to 16.5) | 0.519 | − 1.2 (− 26.1 to 23.7) | 0.923 | − 44.6 (− 69.2 to − 20.1) | < 0.001 | 0.001 |
Week 12 | − 21.9 (− 54.6 to 10.9) | 0.19 | 6.4 (− 39.6 to 26.8) | 0.704 | − 56.3 (− 89.0 to − 23.5) | < 0.001 | 0.001 |
Serum total cholesterol, mg/dL | |||||||
Week 4 | − 3.6 (− 12.1 to 4.9) | 0.406 | − 1.1 (− 9.7 to 7.4) | 0.794 | − 3.8 (− 12.3 to 4.6) | 0.375 | 0.77 |
Week 8 | − 5.3 (− 63.3 to 52.8) | 0.858 | 49.7 (− 9.2 to 108.5) | 0.098 | 12.0 (− 46.0 to 70.1) | 0.684 | 0.25 |
Week 12 | 10.2 (1.1 to 19.4) | 0.029 | − 0.4 (− 9.7 to 8.9) | 0.937 | − 0.3 (− 9.5 to 8.9) | 0.948 | 0.056 |
HDL-C, mg/dL | |||||||
Week 4 | − 0.9 (− 3.6 to 1.7) | 0.49 | − 0.9 (− 3.6 to 1.8) | 0.524 | 0.5 (− 2.2 to 3.1) | 0.731 | 0.674 |
Week 8 | 0.2 (− 2.6 to 3.0) | 0.891 | 0.1 (− 2.8 to 2.9) | 0.969 | 1.1 (− 1.7 to 4.0) | 0.426 | 0.839 |
Week 12 | 3.4 (0.0 to 6.8) | 0.048 | 1.6 (− 1.9 to 5.0) | 0.373 | 2.3 (− 1.1 to 5.7) | 0.185 | 0.249 |
LDL-C, mg/dL | |||||||
Week 4 | − 5.5 (− 12.6 to 1.5) | 0.124 | − 6.6 (− 13.7 to 0.6) | 0.073 | − 1.4 (− 8.5 to 5.6) | 0.693 | 0.207 |
Week 8 | − 1.1 (− 8.6 to 6.5) | 0.779 | − 5.1 (− 12.8 to 2.5) | 0.186 | 2.1 (− 5.4 to 9.7) | 0.58 | 0.294 |
Week 12 | 5.4 (− 2 to 12.9) | 0.151 | − 5.3 (− 12.9 to 2.2) | 0.165 | − 0.3 (− 7.7 to − 7.2) | 0.943 | 0.047 |
ALT, IU/L | |||||||
Week 4 | − 3.8 (− 7.8 to 0.1) | 0.055 | 0.1 (− 3.9 to 4.1) | 0.952 | − 2.3 (− 6.2 to 1.7) | 0.257 | 0.142 |
Week 8 | − 5.0 (− 9.2 to − 0.7) | 0.022 | − 3.2 (− 7.4 to 1.1) | 0.149 | − 7.1 (− 11.3 to − 2.8) | 0.001 | 0.01 |
Week 12 | − 6.5 (− 11.6 to − 1.4) | 0.013 | − 2.2 (− 7.4 to 3.0) | 0.408 | − 7.0 (− 12.1 to − 1.9) | 0.007 | 0.018 |
AST, IU/L | |||||||
Week 4 | − 1.1 (− 3.7 to 1.5) | 0.394 | − 0.3 (− 2.9 to 2.4) | 0.851 | 0.3 (− 2.3 to 2.8) | 0.847 | 0.74 |
Week 8 | − 0.2 (− 2.8 to 2.4) | 0.885 | − 0.2 (− 2.9 to 2.5) | 0.897 | − 0.4 (− 3.1 to − 2.2) | 0.743 | 0.991 |
Week 12 | − 3.7 (− 6.7 to − 0.7) | 0.017 | − 1.2 (− 4.2 to 1.9) | 0.453 | − 2.7 (− 5.7 to 0.3) | 0.081 | 0.083 |
Uric acid, mg/dL | |||||||
Week 4 | − 0.3 (− 0.7 to 0.1) | 0.116 | − 0.3 (− 0.7 to 0.1) | 0.199 | − 0.4 (− 0.8 to 0) | 0.076 | 0.821 |
Week 8 | − 0.8 (− 1.2 to − 0.4) | < 0.001 | − 0.5 (− 0.9 to − 0.1) | 0.02 | − 0.6 (− 1.0 to − 0.2) | 0.004 | 0.005 |
Week 12 | − 0.8 (− 1.2 to − 0.4) | < 0.001 | − 0.6 (− 1.0 to − 0.2) | 0.003 | − 0.8 (− 1.2 to − 0.4) | < .001 | 0.002 |
Visceral fat area, cm2 | |||||||
Week 4 | − 5.1 (− 8.6 to 1.6) | 0.005 | − 3.9 (− 7.5 to 0.4) | 0.031 | − 8.5 (− 12.0 to 5.0) | < 0.001 | < 0.001 |
Week 8 | − 12.6 (− 16.3 to − 8.8) | < 0.001 | − 7.4 (− 11.2 to − 3.6) | < 0.001 | − 17.8 (− 21.5 to − 14.0) | < 0.001 | < 0.001 |
Week 12 | − 14.8 (− 19.3 to − 10.3) | < 0.001 | − 8.4 (− 13.0 to − 3.8) | < 0.001 | − 21.7 (− 26.2 to − 17.2) | < 0.001 | < 0.001 |
Body muscle rate, % | |||||||
Week 4 | 1.6 (− 1.0 to 4.3) | 0.223 | − 1.5 (− 4.3 to 1.1) | 0.249 | 1.9 (− 0 8 to 4.5) | 0.165 | 0.040 |
Week 8 | 1.6 (− 1.7 to 4.8) | 0.335 | − 1.3 (− 4.6 to 2.0) | 0.437 | 3.5 (0.3 to 6.8) | 0.032 | 0.023 |
Week 12 | 3.8 (1.8 to 5.7) | < 0.001 | 0.7 (− 1.3 to 2.80) | 0.475 | 3.3 (1.3 to 5.2) | 0.001 | < 0.001 |