Le Tran, Flatt Shirley W, Natarajan Loki, Pakiz Bilge, Quintana Elizabeth L, Heath Dennis D, Rana Brinda K, Rock Cheryl L
Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA (T.L., S.W.F., L.N., B.P., E.L.Q., D.D.H., C.L.R.).
Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA (B.K.R.).
J Am Heart Assoc. 2016 Jan 25;5(1):e002771. doi: 10.1161/JAHA.115.002771.
Optimal macronutrient distribution of weight loss diets has not been established. The distribution of energy from carbohydrate and fat has been observed to promote differential plasma lipid responses in previous weight loss studies, and insulin resistance status may interact with diet composition and affect weight loss and lipid responses.
Overweight and obese women (n=245) were enrolled in a 1-year behavioral weight loss intervention and randomly assigned to 1 of 3 study groups: a lower fat (20% energy), higher carbohydrate (65% energy) diet; a lower carbohydrate (45% energy), higher fat (35% energy) diet; or a walnut-rich, higher fat (35% energy), lower carbohydrate (45% energy) diet. Blood samples and data available from 213 women at baseline and at 6 months were the focus of this analysis. Triglycerides, total cholesterol, and high- and low-density lipoprotein cholesterol were quantified and compared between and within groups. Triglycerides decreased in all study arms at 6 months (P<0.05). The walnut-rich diet increased high-density lipoprotein cholesterol more than either the lower fat or lower carbohydrate diet (P<0.05). The walnut-rich diet also reduced low-density lipoprotein cholesterol in insulin-sensitive women, whereas the lower fat diet reduced both total cholesterol and high-density lipoprotein cholesterol in insulin-sensitive women (P<0.05). Insulin sensitivity and C-reactive protein levels also improved.
Weight loss was similar across the diet groups, although insulin-sensitive women lost more weight with a lower fat, higher carbohydrate diet versus a higher fat, lower carbohydrate diet. The walnut-rich, higher fat diet resulted in the most favorable changes in lipid levels.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01424007.
减肥饮食中最佳的宏量营养素分布尚未确定。在以往的减肥研究中，已观察到碳水化合物和脂肪的能量分布会促使血浆脂质反应出现差异，并且胰岛素抵抗状态可能与饮食组成相互作用，影响体重减轻和脂质反应。
超重和肥胖女性（n = 245）参加了为期1年的行为减肥干预，并随机分配到3个研究组中的1组：低脂（20%能量）、高碳水化合物（65%能量）饮食；低碳水化合物（45%能量）、高脂肪（35%能量）饮食；或富含核桃、高脂肪（35%能量）、低碳水化合物（45%能量）饮食。本分析重点关注了213名女性在基线和6个月时的血样及可用数据。对组间和组内的甘油三酯、总胆固醇以及高密度和低密度脂蛋白胆固醇进行了定量和比较。6个月时，所有研究组的甘油三酯均下降（P<0.05）。富含核桃的饮食比低脂或低碳水化合物饮食更能提高高密度脂蛋白胆固醇（P<0.05）。富含核桃的饮食还降低了胰岛素敏感女性的低密度脂蛋白胆固醇，而低脂饮食降低了胰岛素敏感女性的总胆固醇和高密度脂蛋白胆固醇（P<0.05）。胰岛素敏感性和C反应蛋白水平也有所改善。
各饮食组的体重减轻情况相似，尽管胰岛素敏感的女性采用低脂、高碳水化合物饮食比高脂肪、低碳水化合物饮食减重更多。富含核桃的高脂肪饮食导致脂质水平出现最有利的变化。
