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阿特金斯、区域、奥尼什和 LEARN 饮食法对超重绝经前女性体重变化及相关风险因素的比较:A 到 Z 减肥研究:一项随机试验。

Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.

作者信息

Gardner Christopher D, Kiazand Alexandre, Alhassan Sofiya, Kim Soowon, Stafford Randall S, Balise Raymond R, Kraemer Helena C, King Abby C

机构信息

Stanford Prevention Research Center and the Department of Medicine, Stanford University Medical School, Stanford, Calif, USA.

出版信息

JAMA. 2007 Mar 7;297(9):969-77. doi: 10.1001/jama.297.9.969.

Abstract

CONTEXT

Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.

OBJECTIVE

To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.

DESIGN, SETTING, AND PARTICIPANTS: Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.

INTERVENTION

Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.

MAIN OUTCOME MEASURES

Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.

RESULTS

Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.

CONCLUSIONS

In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets [corrected] While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00079573.

摘要

背景

流行的饮食方式,尤其是那些低碳水化合物饮食,对当前建议的低脂肪、高碳水化合物减肥饮食提出了挑战。其潜在的益处和风险尚未得到充分测试。

目的

比较4种代表不同碳水化合物摄入量范围的减肥饮食对体重减轻及相关代谢变量的影响。

设计、地点和参与者:2003年2月至2005年10月在美国进行的一项为期12个月的随机试验,对象为311名自由生活的超重/肥胖(体重指数27 - 40)、非糖尿病、绝经前女性。

干预措施

参与者被随机分配遵循阿特金斯饮食法(n = 77)、区域饮食法(n = 79)、学习饮食法(n = 79)或奥尼什饮食法(n = 76),并在2个月内每周接受指导,随后进行额外10个月的随访。

主要观察指标

12个月时的体重减轻是主要观察指标。次要观察指标包括血脂谱(低密度脂蛋白、高密度脂蛋白、非高密度脂蛋白胆固醇和甘油三酯水平)、体脂百分比、腰臀比、空腹胰岛素和血糖水平以及血压。在第0、2、6和12个月评估观察指标。采用图基化极差检验来校正多重检验。

结果

在12个月时,阿特金斯饮食组的女性体重减轻幅度大于其他饮食组,且阿特金斯饮食法和区域饮食法的平均12个月体重减轻差异有统计学意义(P<0.05)。平均12个月体重减轻情况如下:阿特金斯饮食法,-4.7千克(95%置信区间[CI],-6.3至-3.1千克),区域饮食法,-1.6千克(95%CI,-2.8至-0.4千克),学习饮食法,-2.6千克(-3.8至-1.3千克),奥尼什饮食法,-2.2千克(-3.6至-0.8千克)。区域饮食组、学习饮食组和奥尼什饮食组之间的体重减轻无统计学差异。在12个月时,阿特金斯组的次要观察指标与其他饮食组相当或更有利。

结论

在本研究中,被分配遵循碳水化合物摄入量最低的阿特金斯饮食法的绝经前超重和肥胖女性,在12个月时比被分配遵循区域饮食法的女性体重减轻更多,并且与被分配遵循区域饮食法、奥尼什饮食法或学习饮食法的女性相比,经历了相当或更有利的代谢效应[校正后]。虽然关于长期影响和机制仍有疑问,但低碳水化合物、高蛋白、高脂肪饮食可被视为一种可行的减肥替代建议。

试验注册

clinicaltrials.gov标识符:NCT00079573。

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