Foster Gary D, Wyatt Holly R, Hill James O, McGuckin Brian G, Brill Carrie, Mohammed B Selma, Szapary Philippe O, Rader Daniel J, Edman Joel S, Klein Samuel
University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA.
N Engl J Med. 2003 May 22;348(21):2082-90. doi: 10.1056/NEJMoa022207.
Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy.
We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Professional contact was minimal to replicate the approach used by most dieters.
Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [+/-SD], -6.8+/-5.0 vs. -2.7+/-3.7 percent of body weight; P=0.001) and 6 months (-7.0+/-6.5 vs. -3.2+/-5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (-4.4+/-6.7 vs. -2.5+/-6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load.
The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.
尽管低碳水化合物、高蛋白、高脂肪（阿特金斯）饮食很受欢迎，但尚无随机对照试验评估其疗效。
我们进行了一项为期一年的多中心对照试验，纳入63名肥胖男性和女性，他们被随机分配到低碳水化合物、高蛋白、高脂肪饮食组或低热量、高碳水化合物、低脂肪（传统）饮食组。专业接触极少，以复制大多数节食者采用的方法。
在3个月时（平均[±标准差]，体重减轻分别为-6.8±5.0%和-2.7±3.7%；P=0.001）以及6个月时（-7.0±6.5%和-3.2±5.6%，P=0.02），低碳水化合物饮食组的受试者体重减轻幅度大于传统饮食组，但12个月时差异无统计学意义（-4.4±6.7%和-2.5±6.3%，P=0.26）。3个月后，两组在总胆固醇或低密度脂蛋白胆固醇浓度方面无显著差异。在研究的大部分时间里，低碳水化合物饮食组受试者的高密度脂蛋白胆固醇浓度升高幅度和甘油三酯浓度降低幅度均大于传统饮食组。两种饮食均显著降低了舒张压以及口服葡萄糖负荷后的胰岛素反应。
在最初六个月中，低碳水化合物饮食比传统饮食导致的体重减轻幅度更大（绝对差异约为4%），但一年时差异无统计学意义。低碳水化合物饮食与某些冠心病危险因素的更大改善相关。两组的依从性均较差且失访率较高。需要进行更长时间和更大规模的研究来确定低碳水化合物、高蛋白、高脂肪饮食的长期安全性和疗效。
