Similar

weight

Alain

Anne-Fran#{231}oise

Golay,

Gerald

loss with low- or high-carbohydrate

Allaz,

Yves

Morel,

Nicolas

de

Tonnac,

Svetalina

Tankova,

of diets

The goal
that

relative

were

amounts

6-wk

period

persons

low

kcal/d)
was

assigned

composed

body

groups,

and

a function

of diet

fat

15%

neither

plasma

insulin

nor

de-

were

glucose,

that

seen

as

insulin,

decreased
contained

signifi15%

triacylglycerol

1996;63:

loss

not

in response
to
Am J Clin Nutr

174-8.

KEY

Obesity,

high-carbohydrate

weight

loss,

also

received

AND

a body

diet

well

as

attention

is little

is focused

individuals.
When
grams
it is necessary

argument

that

there

are widely

on how

to bring

evaluating
the
to differentiate

obesity

constitutes

different
about

opinions

weight

when

loss

proof

the relation between

changes
in energy balance
and weight loss
(5, 6), the ability
of individuals
to comply
with a weight-loss
diet (7), and the long-term
success of any weight-loss
program
in preventing

a return

these issues
this instance,
been

appears

to the original

consensus
argued

has

that

when

changes

patients

containing
drate.

The

tions,

and

changes
174

were

moderate,

present

study

weight

reached.
lead

was

high

initiated

several

For

in

example,

obese
of

of
these

30,

>

with

strong

psychiatric

of a history

personal

diagnoses,

was submitted

of the Department

to a low-energy
multidisciplinary

nutritional

motivation,

were

excluded

to and accepted

of Medicine

consisted

and

diet,

subjects

program

that

education,

Exercise

day

by

at Geneva

and
of

standard

was

by

tech-

exercise

physical

provided

in a
physical

behavioral

1 h of aerobic

1 h of underwater
education

participated
included

training

activity

per

a registered

day.

dietitian

twice a week (once in a group session

and once individually).
The behavioral
approach
consisted
of six sessions,
during
which issues of self-control,
cognitive
restructuring
reinforcement, and relapse
prevention
were addressed.
On

admission

signed

to the

to receive

consisted

hospital,

diets

of either

From

and

patients

containing

15%

or 45%

randomly

as-

4.2

Mi/d

were
(1000

kcal/d)

that

of

energy

as

carbohydrate.

diets

Clinical

Address

Unit,

observa-

Geneva

patients

of the
and
Nutr

the

Department

University

of Medicine,

School

Center,

Geneva

of Medicine

Department

University

and Geriatric

of Veterans

Affairs

Hospital,

Research,
Medical

and

Education
Center,

Palo

Alto, CA.

carbohy-

J Clin

on the basis

Hospital.

Stanford

carbohydrate
Am

education.

it

similar

(1200-kcal/d)

per

loss

weight

were

proportions

in 43

of

that both

to extend

facets

first

but even
weight

variables

5.0-MJ/d

and

The

to better

indicate

metabolic

a comparison
and

been

et al (12)

prescribed

low,

(8-10).

straightforward,

diets

in associated

involved
in

not

low-fat

( 1 1), but data from Alford

and

weight

to be the most

were
which

nutritional

decided

The protocol

committee

Nutritional

in obese

efficacy
of weight-loss
between
considerations

it was

(kg/rn2)

those

University

niques.

(1-4),

visit,

index

the study.

activity,
there

patients
during

METHODS

first

mass

the ethical

INTRODUCTION

hazard

and

lowfrom

compliance,
of the study,

behavioral

of

of energy

and the ability to participate

in the requisite
amount of physical
activity.
Patients
with obesity
secondary
to endocrine
disease,
from

low-carbohydrate

the

structured,

Although

dietary
duration

initiation

or 45%

of failure to lose weight

in response
to ambulatory
treatment
that these individuals
would benefit
if they were hospitalized
for the first 6 wk of treatment.
Criteria
for admission
included

In addition

health

the

15%

Forty-three
adult, obese patients
were studied
before
and
after a 6-wk period of hospitalization.
These subjects
had been
referred
to the Obesity
Outpatient
Clinic of the Department
of
Medicine
at Geneva
University
Hospital
for dietary
treatment
of their obesity.

as

WORDS

diet,

weight
period.

they

followed

of either

To increase
for the entire

During

con-

centrations
fell significantly
in response to the higher-carbohydrate
diet. The results of this study showed that it was energy intake,
nutrient
composition,
that determined
low-energy
diets over a short time

carbohydrate.
hospitalized

SUBJECTS

0.6 kg) or

did not vary

plasma

that

consisting

and 26%
of weight

circumference

Fasting

diets

carbo-

significant

of the changes

composition.

but

(8.9

metabolism

energy

time

4.2

15%

Furthermore,

waist-to-hip

obese

containing

protein,

in the amount

either

the magnitude

during

45% carbohydrate,

difference

and

diets

32%

cholesterol,
and triacylglycerol
concentrations
cantly
in patients
eating
low-energy
diets
carbohydrate,

weight

lipoprotein
in

1996;63:174-8.

reprint

Department

requests
of

to A Golay,

Medicine,

Diabetes

University

of

Treatment
Geneva

and Teaching
Hospital,

1211,

14, Switzerland.

Received

November

Accepted

for publication
Printed

in USA.

14, 1994.
October
1996

17,
American

1995.
Society

for Clinical

Nutrition

Downloaded from www.ajcn.org by on August 11, 2009

in total

different

43 adult,

to receive

loss in response
to diets containing
45% (7.5 0.5 kg) carbohydrate.
in both

the effect

widely

on body

of either

no significant

creases

to evaluate

but

Consequently,

and 53% fat, or 29% protein,

fat. There

was

in energy

of fat and carbohydrate

randomly

(1000

hydrate,

of this study

equally

of hospitalization.

were

MJ/d

loss

and

Reaven

ABSTRACT

has

WEIGHT
Baseline

characteristics

listed

in Table

distribution,

mass

started

on

tions

of the

two

of

rotation

for

lunch

diets.
2. Both

and

A 7-d

the

menus

rotational

nutrient

menu

but

meals
and

were
during

compliance

instructed
with

once

a week

took

the quality

meal

The

patients

the

and

software

PRODI3+

tary plans and food records

were from Souci
et al (14)

The absolute

amount

(1 15 14 compared
less

with

5 g). Both
diets
contained
(
14 g/d) and cholesterol

Urinary

nitrogen

a l-d
These

food

used

to calculate

measured

11514

155

455

Fat

(g/d)

605

305

(%)
Protein

535

265

(gld)

799

735

(%)

325

295

SD.

by the

and

record

age

(skinfold

used

times

diet

of fat was
with 60

Kjeldahl

with

these

six

urine
urinary

collections.

fat

method

were

mated

on

mg/kg

body

the

calculated

basis
wt,

by

umental

of previously

respectively
from

total
dietary

at

TABLE

Physical

characteristics

biceps,

Daily

output

(urine,

subscapula,

Age(y)

3M,

l9F)

419
(kg)

107 23

Height

(cm)

162

(kg/m2)

41

BP (mm Hg)
BP

(mm

Hg)

iE SD.

BP,

blood

stool,

and

10
was

integ-

of adiposity
were
skinfold-thickness
and

suprailiac

138 14
89 9
pressure.

45%

Carbohydrate

6M,

(n

1SF)

4518

Weight

Diastolic

5 and
balance

102
164

18

38 5
136

18

85

14

(r

(23).

two

techniques

0.64,

P <

as a mean

and

of these

bioelectrical

analyzed

as means

analysis

approach

compo-

were

0.0001).
two

SEMs

signifPercent-

measurements

and

procedure

by two-way

Body

impedance).

general-linear-models

were

of SAS

analyzed

(SAS

Insti-

between
the two
weight
loss,
data

of variance,

of Scheff#{233}(24,

with

the mul-

25).

RESULTS
Values

for

cumferences,
in Table

total

body

and
4. These

weight,

body

waist-to-hip
ratio
values
were not

fat,

waist

before
the
significantly

and

hip

diets are
different

cirgiven
be-

tween the two groups

at baseline
nor was there a significant
difference
in the amount
of weight
loss in response
to diets
containing

either

fat,

15%

waist

and

or 45%
hip

significantly

the changes
percentage

weight

groups,

as a function

vary

loss

and

the two groups

Daily dietary
nitrogen
(1 5%-carbohydrate
diet)
similar

carbohydrate.

circumference,
in both

did not

the

was

1 .3 0.5

0.6

g (45%-carbohydrate

of both

during

1 .8

during
the last S wk.
Table
5 lists
values

HDL-cholesterol,

tions

and

after

for

cholesterol,
before

the

though

trends

diets,

the

of
The

were

equal:

more

groups.

nitrogen

compared

balance
week F- I .5

the first
0.2 g (45%
fasting

dietary

plasma
intervention,

more

0.2

(15%
than

glucose,

triacylglycerol

were

-0.5

was

carbohydrate)]

significantly
contained
15%

direction

The

balance

with

Nitrogen

and

decreased
which

in a similar

loss

between

was

these indexes
were not significantly
different
groups
before
dieting.
These
data also show
glucose,
insulin,
cholesterol,
HDL-cholesterol,
erol concentrations
the low-energy

magnitude

composition.

were
not significantly
diet) compared
with

diet)

diet).

diet

and

fat

diet)]
diets

(15%-carbohydrate
each
and

ratio

percentage

1 1 .2 0.9 g (45%-carbohydrate
effect

total

waist-to-hip

of diet

carbohydrate
diet)]
and nitrogen
losses
different
[13.9 1.7 g (15%-carbohydrate
protein-sparing

Furthermore,
and

than were the absolute

changes.
intake
was similar
[12.6
0.3 g
compared
with 1 1 .7 0.2 g (45%-

in

negative
with
carbohydrate)

Carbohydrate

(F1

Systolic

esti-

subjects
15%

BMI

were

studies:
nitrogen

percentage
techniques:

triceps,

of the

losses

input.

Body
fat composition
and
determined
by two different
measurements

stool

reported

(21).

subtracting

losses)

and

expressed

tiple-comparison

body

samples
were collected
every week
loss was computed
on the basis of

Integumental

linear

are expressed

the

decreased

Twenty-four-hour
and average
daily

and

thickness

analysis

by these

tute mc, Cary, NC). To evaluate

the difference
groups
of obese
patients,
before
and after

higher

saturated

of fat was

Data

alimen-

impedance

as assessed

correlated

into

ac-

bioelectrical

values

records

15%-carbohydrate

of

(22),
icantly

(20).

375

sition

tables
(15).

was three

in the

was

food

consumed

similar
amounts
(230
mg/d).

was

320

(%)

verify

Blood was drawn after a 14-h overnight

fast before and after
6 wk of the low-energy
diets for measurements
of plasma
glucose
( 16), plasma immunoreactive
insulin ( 17), cholesterol
( 18), high-density-lipoprotein
(HDL)-cholesterol,
and triacylglycerol
concentrations
( 19). Nitrogen
balance
was measured
to compare
the protein-sparing
effect
of the two low-energy
diets.

4296

315

4214

(g/d)

The

To

37 S g), and the amount

diet (30 5 compared

45%-carbohydrate

in the

than

(22%),

a dietitian

(13). Food composition

and Renaud
and Attil

diet

di-

(12%).

of food

of carbohydrate

in the 45%-carbohydrate

and

study.

was

The

I d of the

compliance.

completed

the quantity

used.
offered

snack

foods

6 wk of the

food

(kI/d)

Carbohydrate

two diets were similar.

for each
patient.
All

to improve

the diet,

during

all

Energy

Carbohydrate

45%

Carbohydrate

insulin,

concentraand

shows

that

between
the two
that fasting
plasma
and triacylglycin patients
carbohydrate.

seen when

eating
Al-

patients

ate

Downloaded from www.ajcn.org by on August 11, 2009

count.

to eat

each

of diets

Composi-

breakfast

bedtime

Composition

diets

high-carbohydrate

among

total energy
and protein
contents
of the
Energy
intake
was carefully
measured
present

was
from

and

TABLE

15%

con-

I 75

DIETS

patients

various

of

low-carbohydrate

(33%),

of

composition

compositions

dinner

subjects

the

in Table

Recipes

are
of sex

HIGH-CARBOHYDRATE

pressure.

experimental

in Table
3.
intake
was distributed

(33%),

blood

acquired,

two

similar

diets are given

Daily energy

and

were

OR

groups

shown

Itemized

menu

index,

LOW-

in terms

are

standardized.

foods.

experimental
comparable

data

foods.

provided

verse

WITH

of the

diets

natural

were

menus

one

two

were

metabolic

were

items

body

baseline

sisted

the

groups

age,

After

of

1. The

LOSS

GOLAY

176
TABLE

Itemized

composition

ET AL
DISCUSSION

of diets

Food

In this study
Weight

items

varied

carbohydrate

15% Carbohydrate

points.

Breakfast

Low-fat

fresh

Low-fat

ham

cheese

(20%

fat)

meat

or fish

Vegetable

closely
variations

100

beneficial

sweetened

180

yogurt

Low-fat

meat

or eggs

100

Whole-wheat

bread

15

Snack
fresh

cheese

(20%

fat)

Carbohydrate

and

fasting

plasma

of weight

lipid

glucose,

150
50

150
60
100

sweetened

yogurt

180

Vegetable

pasta,

or cereals

thermic

150
60

(4%)

fresh

cheese

(20%

1g

fat)

Fruit

low-energy

diets

tude
of the differences
insulin
nor triacylglycerol
response

to the

TABLE 4
Body composition

containing

45%

carbohydrate,

was
attenuated
concentrations

higher-carbohydrate

diet.

before

loss

and after weight

more

the tendency
of this

Body

tion

neither
plasma
significantly
in

ingested,

dependent

effect

issue

circumference

99

on

weight

in

fat intake
differences

et al. First,

and prob-

in

degree

For
the

weight

example,

thermic

a thermic

of

ie, a 100-i
to fat

on

the

of fat
it has
to fat,

other

hand,

the

diets

containing

4.2

of carbohydrate

is

of 50 J associated
difference

in hypoenergetic
loss

the

diets

increasing

weight

that the
that

of low-energy

of 45%

effect

that

On

effect
when

effect

than

considerations,
of carbohydrate

(27).

to the

unlikely

is the evidence
is higher

of these
the ratio

102

42

that

per

the

day.

relative
diets

ensues

with
Thus,
propor-

will

have

in compliant

104

loss:

p <

0.001,

P < 0.01,

1 13

121 2

0.93

0.05.

95

32

7.4 0.6

32

<

41

1.0

11732
0.88 0.0l

0.02

After

b efore

low

Before

38 22

1264

from

diets

variations

(8%)

0.5

17.7

1 15 4
0.91

different

and
that

45% Carbohydrate

8.3

Hipcircumference(cm)
Waist-to-hip
ratio
i SEM.
2--I
Significantly

47 3
(cm)

one,
reported

consuming

to address

to gain

of carbohydrate

significant

After

Fat loss (%)

Waist

two

patients.

107

fat (kg)

is a pragmatic

of Rabast

information

be questioned.
are

it is theoretically

Before
(kg)

in

in subjects

decrease
in dietary
are two crucial

15% Carbohydrate

Total body weight

Weight loss (%)

fall

triacylglycerol,

et al (1 1), who

weight

a consequence
that the higher

relevance
MJ

the magni-

and
fell

first

of carbohydrate

the less
must

less

150 J, compared
with
eating 15% carbohydrate,
the

The

and those

important

effect
(26).
As
suggested

been

Snack
Low-fat

the

compliance.

100

Oil

of carbo-

was decreased

of Rabast

lost

are

A second
meat or eggs

cholesterol,

and that a simple

weight
loss.
There

to

and

dietary

Dinner

Low-fat

addressed.

our results

output,

Snack

artificially

measures

ably
most
important,
the current
studies
were
performed
on
inpatients,
not outpatients.
Second,
subjects
in our study
also
participated
in programs
of physical
exercise
and both behavioral and nutritional
education.
Consequently,
we believe
that
the results
of our study
emphasize
issues
of energy
intake
and

Oil

Low-fat,

be

individuals

between

100

Fruit

insulin,

to

the other
hand,
to modify
the

specifically,

concentrations

the publications

carbohydrate,
can lead

or cereals

More

end-

in response

of the amount
of
being
related
most

loss on certain

metabolism.

and

metabolic

similar

independent
test diets,

that

fat

0.02

34 22

16.8

1.2

103

32

11222
0.91

0.02

Downloaded from www.ajcn.org by on August 11, 2009

pasta,

must

obese

Vegetable

Rice,

effects

involves

50

Breakfast
Low-fat skimmed
milk (0% fat)
Whole-wheat
bread
Butter or margarine
Lunch
Low-fat meat or fish
Rice,

apparently
in the two

various

was

to total energy
intake
(Table
3). On
in dietary
composition
did appear

hydrate

issues

Low-fat

and

loss

diets
of

tions were not statistically

significant
in these
subjects.
To put the results
of the current
study
into perspective,

25

Oil

loss

proportions

eating a low-energy
diet relatively
high in carbohydrate,
and
the changes
in plasma
insulin
and triacylglycerol
concentra-

100

Vegetable

45%

was

of low-energy

relative

of weight

and HDL-cholesterol

Dinner

the effects

their

weight

amount

100

Snack

artificially

on both

The

the two diets, and

fat or carbohydrate

Oil
Low-fat,

in

150
50

Lunch

Low-fat

we evaluated

substantially

WEIGHT
TABLE

LOSS

WITH

LOW-

OR

HIGH-CARBOHYDRATE

indexes

before

and

after

weight

loss

Carbohydrate

15%

45% Carbohydrate

Before
Plasma
Plasma
Plasma
Plasma

glucose (mmolIL)
insulin (pmol/L)
cholesterol
(mmol/L)
HDL cholesterol
(mmoLfL)

Plasma

triacylglycerol

5.3 0.2
106.8 15.6
5.7

(mmolIL)

Significantly

In

different

conclusion,
loss

diets

from

our
can

weight

results

occur

as inpatients,

before

and

subjects

that

this

0.3

the

high-carbohydrate

of

low-fat,

4.4

0.12

57.6

6.62

4.5

0.22

advocated

tion
Program
insulin
and

(28)
seems
triacylglycerol

likely
insulin

related
and

portion
tion,

to previous
triacylglycerol

to dietary
the

by

carbohydrate

servation

that

in

weight

ate low-energy
and carbohydrate
diets
that are

loss

advocacy

similar

0.001,

p <

of this
that

dietary

low-fat

such
information
to suggest
that

composition,
low-energy

that
diets.

We are grateful

by

shown

to

this

loss

it

13.
14.

in

of

seems
energy

not
response

of the dietary

especially

staff

T Lehmann,

P Rigoli,

16.

of

C Bussien,

persons

coronary

Sparrow

disease

D, Wishewski

risk:

patterns

C, Vokonas
of

risk

factor

long-term
weight change. Am I Epidemiol
2. Burton BT, Foster WR. Health implications
development
Itallie

TB.

States.

Anderson

Brodoff
5. Leibel
patients.

6. Golay

subjects.

and

Philadelphia:

fat diets.

lB Lippincott

BB,

AC,

protein

values

Assoc

1990;90:534-40.

Kluthe

EhI

and

and nutrient

B. Prodi

vises.

Switzerland:

Souci

SW,

3+.

intake

W,

Kraut

diet.

The

effects

the

diet

logical

of

for

of food

Nutr

in
loss,

I Am Diet

and nutritional

food

H. Tables

water

Ann

weight

women.

1989.

and

of variations
upon

obese

Freiburg,

of

sodium

of

of adult

Interactive

methods

carbohydrate

RD.

content

University

Fachmann

of weight,

or low

Hagen

fat

comparative

1980:15-21.

M. Loss

a high

Blankenship

blood

Libbey,

ad1989/

composition

63,

Kadish

1986
AH,

(in French).
Litle

Clin

Chem

Herbert
Allain

RL,

Sternberg

of glucose

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