J Pérez-Guisado

In addition to the fact that an equal number of calories are ingested, KDs are more effective for achieving fat loss than conventional high-carbohydrate/low-fat diets. Low-carbohydrate diets have even proved to be more effective than conventional diets for more selective fat loss and conserving muscle mass [ 26 , 77 ]. Benoit et al. reported that when a 1000 kcal KD (10 g of carbohydrates/day) was consumed for 10 days, seven male subjects lost an average of 600 g/day, of which 97% was fat [ 77 ]. Young et al. [ 26 ] compared three diets, each consisting of 1800 kcal, but containing different proportions of carbohydrates (104 grams, 60 grams and 30 grams, respectively) and observed a negative correlation between the proportion of carbohydrates in the diet and weight loss and a positive correlation with lean weight loss. Thus, the lowest carbohydrate diet proved to be most effective way of losing weight and conserving muscle mass. Willi et al. [ 78 ] also concluded that the use of a low-carbohydrate diet in adolescents with morbid obesity was effective for weight loss and conserving muscle mass. Sondike et al. [ 28 ] found that the use of a low-carbohydrate diet in adolescents without calorie restrictions in fats and proteins was a more effective way of losing weight than a low-fat diet and significantly improved triglyceride and cholesterol levels. The aforementioned authors also affirmed that in adolescents on a low-carbohydrate diet with no calorie restriction in terms of fats and proteins, despite consuming an average of 700 Kcal more per day than the group on the low-fat diet, weight loss was more than double and the improvement in the level of triglycerides was more pronounced [ 79 ]. These findings were also confirmed by Greene et al. [ 27 ], who showed that with an equal number of calories and even increasing the number of calories by 300 or more, low-carbohydrate diets foster greater weight loss than low-fat diets. Samaha et al. performed a six-month study and found that severely obese subjects with a high prevalence of diabetes or metabolic syndrome lost more weight over the course of six months on a carbohydrate-restricted diet than on a calorie-fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost [ 80 ]. Yancy et al. [ 81 ] also conducted a six month study and concluded that a low-carbohydrate diet program achieved better participant adherence and greater weight loss than a low-fat diet program. All these studies have one important limitation: the study period in each case was never longer than 6 months. However, Foster et al. and Stern et al. [ 82 , 83 ] compared low carbohydrate diets to traditional diets (low calorie-high carbohydrate diets in clinical trials) for weight loss over the course of one year. In both clinical trials, low carbohydrate diets produced greater weight loss than the conventional diet for the first six months, but the differences were not significant at 1 year. In both diets, adherence was poor but, the participants on the low-carbohydrate diet displayed more favorable overall outcomes at 1 year than those on a conventional diet. Dansinger et al. [ 84 ], in another one-year clinical trial, compared the effectiveness of 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and reported that overall dietary adherence rates were low, although increased adherence was associated with greater weight loss for each diet group. All 4 diets resulted in modest statistically significant weight loss at 1 year, with no statistically significant differences between diets. Brinkworth et al. [ 85 ] performed a clinical intervention study on two groups of subjects randomly assigned to either a standard protein or high-protein diet. These authors also reported poor long-term dietary adherence behavior for both dietary patterns at month 17. Taking into account all these long-term studies, the real problem associated with long-term diets is poor adherence. People get bored following the same food patterns. Therefore strong willpower is needed to achieve better adherence.

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