Both the Mediterranean diet and the low-carbohydrate (Atkins) diet proved to be as safe and effective for inducing weight loss in moderately obese subjects as was the American Heart Association's low-fat, restricted-calorie diet, according to a report.
In a 2-year randomized controlled trial in which adherence rates ranged from 78% to 90%, the low-carb and Mediterranean diets produced beneficial metabolic effects in addition to weight loss, suggesting that their dietary strategies might be considered for use in clinical practice and that “diets might be individualized according to personal preferences and metabolic needs,” said Dr. Iris Shai of Ben-Gurion University of the Negev, Beer-Sheva, Israel, and her associates.
In particular, the low-carbohydrate diet that allows unrestricted caloric intake as long as carbohydrate content is kept to a minimum “may be optimal for [patients] who will not follow a restricted-calorie dietary regimen,” they noted.
The researchers compared the three diets in a workplace study involving 322 participants with a mean body mass index (BMI) of 31 kg/m
The participants were weighed monthly in the workplace, and adherence to diets was monitored with food frequency questionnaires. At 2 years, the adherence rates were 78% with the low-carbohydrate diet, 85% with the Mediterranean diet, and 90% with the AHA low-fat, low-calorie diet.
“We believe that similar strategies to maintain adherence could be applied elsewhere” outside of the workplace environment, Dr. Shai and her associates wrote.
Daily energy intake decreased significantly and to a similar extent in all three groups. The mean weight loss was 3.3 kg with the AHA diet, 4.6 kg with the Mediterranean diet, and 5.5 kg with the low-carbohydrate diet, the investigators said (New Engl. J. Med. 2008;359:229–41).
All three groups also had significant and similar decreases in BMI, waist circumference, blood pressure, and insulin levels.
The low-carbohydrate diet produced the greatest improvement in lipid profiles, with a 20% relative decrease in the total cholesterol to HDL cholesterol ratio, compared with a 12% decrease for the AHA diet.