Abstract
Purpose
Metabolic syndrome (MetS) is a major public health concern that increases the risk
of cardiovascular disease and mortality. In previous studies of MetS management, low-carbohydrate
diets have been strongly emphasized, despite the fact that many apparently healthy
individuals have difficulties adhering to these diets on a long-term basis. The purpose
of the present study was to elucidate the effects of a moderately restricted carbohydrate
diet (MRCD) on cardiometabolic risk factors in women with MetS.
Methods
This parallel 3-month, single-blind randomized controlled trial was conducted in Tehran,
Iran, among 70 women with overweight or obesity aged 20 to 50 years with MetS. Patients
were randomly allocated to receive either MRCD (42%–45% carbohydrates and 35%–40%
fats) (n = 35) or a normal weight loss diet (NWLD) (52%–55% carbohydrates and 25%–30%
fats) (n = 35). Both diets contained the same quantity of protein, which accounted
for 15% to 17% of total energy. Anthropometric measurements, blood pressure, lipid
profile, and glycemic indices were all assessed before and after the intervention.
Findings
Compared with the NWLD group, following an MRCD significantly decreased weight (−4.82
vs −2.40 kg; P = 0.01), body mass index (−1.88 vs −0.94 kg/m2; P = 0.01), waist circumference (−5.34 vs −2.75 cm; P = 0.01), hip circumference (−2.58 vs −1.11 cm; P = 0.01), serum triglyceride (−26.8 vs −7.19 mg/dL; P = 0.01), and increased serum HDL-C levels (1.89 vs. 0.24 mg/dL; P = 0.01). There was no significant difference between the 2 diets in waist-to-hip
ratio, serum total cholesterol, serum LDL-C, systolic and diastolic blood pressure,
fasting blood glucose, insulin levels, or the homeostasis model assessment for insulin
resistance.
Implications
Moderate carbohydrate replacement with dietary fats significantly improved weight,
body mass index, waist circumference, hip circumference, serum triglyceride, and HDL-C
levels among women with MetS. Iranian Registry of Clinical Trials identifier: IRCT20210307050621N1.
Graphical Abstract
Graphical Abstract
Key words
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References
- The global epidemic of the metabolic syndrome.Curr Hypertens Rep. 2018; 20: 1-8
- Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly: a meta-analysis of prospective cohort studies.Med Sci Sports Exerc. 2017; 96: e8491
- Metabolic syndrome, diabetes and cardiovascular events: current controversies and recommendations.Minerva Cardioangiol. 2006; 54: 195-214
- Geographic distribution of metabolic syndrome and its components in the general adult population: a meta-analysis of global data from 28 million individuals.Diabetes Res Clin Pract. 2022; 188109924
- Prevalence of metabolic syndrome in Iran: a meta-analysis of 69 studies.Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019; 13: 792-799
- Does the new International Diabetes Federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? findings from the British Women's Heart and Health Study.Diabetologia. 2006; 49: 41-48
- Hepatic insulin resistance, metabolic syndrome and cardiovascular disease.Clin Biochem. 2009; 42: 1331-1346
- Lifestyle modification in the management of the metabolic syndrome: achievements and challenges.Diabetes, metabolic syndrome and obesity: targets and therapy. 2010; 3: 373
- Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease.Endocrine, Metabolic & Immune Disorders-Drug Targets. 2016; 54: 681-690
- Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects.Metabolism. 2013; 62: 1779-1787
- Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome.Scand Cardiovasc J. 2008; 42: 256-263
- Low-carbohydrate diets for the treatment of obesity and type 2 diabetes.Curr Opin Clin Nutr Metab Care. 2018; 21: 308-312
- Effects of weight loss during a very low carbohydrate diet on specific adipose tissue depots and insulin sensitivity in older adults with obesity: a randomized clinical trial.Nutr Metab (Lond). 2020; 17: 1-12
- Low carbohydrate and low-fat diets: what we don't know and why we should know it.Nutrients. 2019; 11: 2749
- Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss.JCI Insight. 2019; 4e128308
- The effects of low-carbohydrate diets on cardiovascular risk factors: a meta-analysis.PLoS One. 2020; 15e0225348
- Major dietary patterns in relation to general obesity and central adiposity among Iranian women.J Nutrition. 2008; 138: 358-363
- Moderate replacement of carbohydrates by dietary fats affects features of metabolic syndrome: a randomized crossover clinical trial.Nutr Metab (Lond). 2014; 30: 61-68
- Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women.Am J Clin Nutr. 2004; 79: 204-212
- metabolism. Increased ratio of dietary carbohydrate to protein shifts the focus of metabolic signaling from skeletal muscle to adipose.Nutr Metab (Lond). 2011; 8: 1-7
- Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials.Am J Clin Nutr. 2012; 96: 1281-1298
- The effects of low-fat, high-carbohydrate diets vs. low-carbohydrate, high-fat diets on weight, blood pressure, serum liquids and blood glucose: a systematic review and meta-analysis.Eur J Clin Nutr. 2022; 76: 16-27
- Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome.Prog Lipid Res. 2008; 47: 307-318
- The effect of “moderately restricted carbohydrate” diet on gut microbiota composition and metabolic parameters in women with metabolic syndrome: a study protocol for a randomized controlled trial.Trials. 2022; 23: 1-10
- Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).JAMA. 2001; 285: 2486-2497
- Tutorial in biostatistics: sample sizes for parallel group clinical trials with binary data.Stat Med. 2012; 31: 2904-2936
- The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass.Am J Clin Nutr. 1984; 40: 168-182
- Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials.Br J Nutr. 2016; 115: 466-479
- Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose-response meta-analysis of cohort studies.Lipids Health Dis. 2019; 18: 1-14
- Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis.World Health Organization;. 2016;
- Consumption of hydrogenated versus nonhydrogenated vegetable oils and risk of insulin resistance and the metabolic syndrome among Iranian adult women.Diabetes Care. 2008; 31: 223-226
- Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man.Diabetologia. 1985; 28: 412-419
- 2011 Compendium of Physical Activities: a second update of codes and MET values.Med Sci Sports Exerc. 2011; 43: 1575-1581
- A mixed model approach for intent-to-treat analysis in longitudinal clinical trials with missing values.RTI Press, 2019
- Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016.JAMA. 2018; 319: 1723-1725
- Metabolic syndrome update.Trends Cardiovasc Med. 2016; 26: 364-373
- Dietary intervention for overweight and obese adults: comparison of low-carbohydrate and low-fat diets: a meta-analysis.PLoS One. 2015; 10e0139817
- Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study.BMC Med. 2014; 12: 1-9
- Effects of low carbohydrate diet compared to low fat diet on reversing the metabolic syndrome, using NCEP ATP III criteria: a randomized clinical trial.BMC Nutr. 2021; 7: 1-9
- Effects of a low carb diet and whey proteins on anthropometric, hematochemical, and cardiovascular parameters in subjects with obesity.Endocrine, Metabolic & Immune Disorders-Drug Targets. 2020; 20: 1719-1725
- Pretreatment fasting plasma glucose and insulin modify dietary weight loss success: results from 3 randomized clinical trials.Am J Clin Nutr. 2017; 106: 499-505
- Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: a randomised clinical trial.Peer J. 2019; 7: e6273
- The effects of different degrees of carbohydrate restriction and carbohydrate replacement on cardiometabolic risk markers in humans—a systematic review and meta-analysis.Nutrients. 2020; 12: 991
- Carbohydrate restriction improves the features of metabolic syndrome: metabolic syndrome may be defined by the response to carbohydrate restriction.Nutr Metab (Lond). 2005; 2: 1-17
- Dietary intake of linoleic acid, its concentrations, and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective cohort studies.Diabetes Care. 2021; 44: 2173-2181
- Causes and consequences of hypertriglyceridemia.Front Endocrinol (Lausanne). 2020; 11: 252
- Thrombosis, biology v. selective hepatic insulin resistance, VLDL overproduction, and hypertriglyceridemia.Arterioscler Thromb Vasc Biol. 2012; 32: 2104-2112
- Efficacy of a moderately low carbohydrate diet in a 36-month observational study of Japanese patients with type 2 diabetes.Nutrients. 2018; 10: 528
- Low-carbohydrate diet and cardiovascular diseases in Iranian population: Tehran Lipid and Glucose Study.Nutr Metab Cardiovasc Dis. 2020; 30: 581-588
Article info
Publication history
Published online: March 04, 2023
Accepted:
February 8,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Elsevier Inc.
