Carbohydrate for weight and metabolic control: where do we stand?

Changes in lifestyle are considered to play an important role in the etiology of obesity and type 2 diabetes, and improvements in diet and physical activity are the first-choice treatment for these metabolic diseases. Since the dietary recommendations of almost 40 y ago that fat should be decreased and that carbohydrate should be increased, recommendations for a healthy diet, except for minor amendments, have not changed that much. It is generally considered that caloric restriction is more important than changes in the macronutrient composition of the diet for weight loss and body weight control. Although this is true, there is increasing evidence that changes in the macronutrient composition of the diet (decreasing carbohydrate and increasing unsaturated fats and/or protein) play a role that facilitates weight loss, increases insulin sensitivity and glucose tolerance, and improves cardiovascular risk factors, such as blood pressure, blood lipid profile, and inflammatory markers, often independent of weight loss. Low-carbohydrate diets, whether they be high in unsaturated fats and/or protein, are not recommended by the American Diabetes Association; however, despite this the Joslin Diabetes Center currently advocates a diet composition of approximately 40% carbohydrate, 30% fat, and 30% protein energy for overweight and obese adults with type 2 diabetes or prediabetes or those at high risk of developing type 2 diabetes. Hopefully, future studies will indicate whether diets with a more equilibrated macronutrient composition than presently recommended are more appropriate for body weight and metabolic control.