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一項研究顯示，低碳水化合物飲食在減肥和改善血脂指標方面，明顯優於傳統的低脂飲食。試驗中的參與者在低碳水化合物飲食下，不僅體重減輕幅度更大，而且三酸甘油水平顯著下降，高密度脂蛋白膽固醇水平有所提升，顯示出低碳水化合物飲食在治療肥胖和高脂血症上的潛力。

低碳水化合物、生酮飲食對抗低脂飲食治療肥胖和高脂血症：一項隨機對照試驗

A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial

William S Yancy Jr 1, Maren K Olsen, John R Guyton, Ronna P Bakst, Eric C Westman 

 doi: 10.7326/0003-4819-140-10-200405180-00006.

https://pubmed.ncbi.nlm.nih.gov/15148063/

摘要

背景

儘管科學證據匱乏，低碳水化合物飲食仍然受到廣泛關注。

目標

比較低碳水化合物、生酮飲食方案與低脂、低膽固醇、減熱量飲食的效果。

設計

隨機對照試驗。

設置

門診研究診所。

參與者

來自社區的120名超重、高脂血症志願者。

干預

低碳水化合物飲食（最初每日碳水化合物攝入量<20克）加上營養補充、運動建議和小組會議，或低脂飲食（脂肪能量佔總能量的＜30%，每日膽固醇攝入量＜300毫克，每日熱量赤字500至1000千卡）加上運動建議和小組會議。

測量

體重、體組成、空腹血清脂質水平和耐受性。

結果

低碳水化合物飲食組完成研究的比例高於低脂飲食組（76% 對 57%；P = 0.02）。在24週時，低碳水化合物飲食組的體重減少優於低脂飲食組（平均變化為 -12.9% 對 -6.7%；P < 0.001）。兩組患者的脂肪質量減少均較多（低碳水化合物飲食組改變為 -9.4 公斤，低脂飲食組改變為 -4.8 公斤），而脂肪無關質量的減少則較少（分別改變為 -3.3 公斤 對 -2.4 公斤）。與低脂飲食組相比，低碳水化合物飲食組的血清三酸甘油水平下降較多（改變為 -0.84 mmol/L 對 -0.31 mmol/L [-74.2 mg/dL 對 -27.9 mg/dL]；P = 0.004），高密度脂蛋白膽固醇水平增加較多（0.14 mmol/L 對 -0.04 mmol/L [5.5 mg/dL 對 -1.6 mg/dL]；P < 0.001）。低密度脂蛋白膽固醇水平的變化在統計上沒有差異（低碳水化合物飲食組改變為 0.04 mmol/L [1.6 mg/dL]，低脂飲食組改變為 -0.19 mmol/L [-7.4 mg/dL]；P = 0.2）。低碳水化合物飲食組的輕微不良反應更為頻繁。

限制

我們無法明確區分低碳水化合物飲食的效果和僅供該組使用的營養補充劑的效果。此外，參與者身體健康，隨訪時間僅為24週。這些因素限制了研究結果的泛化能力。

結論

與低脂飲食相比，低碳水化合物飲食方案的參與者保留更好，體重減少更大。在積極減重期間，低碳水化合物飲食組的血清三酸甘油水平下降更多，高密度脂蛋白膽固醇水平增加更多，而低脂飲食組則較少。

Abstract

Background

Low-carbohydrate diets remain popular despite a paucity of scientific evidence on their effectiveness.

Objective

To compare the effects of a low-carbohydrate, ketogenic diet program with those of a low-fat, low-cholesterol, reduced-calorie diet.

Design

Randomized, controlled trial.

Setting

Outpatient research clinic.

Participants

120 overweight, hyperlipidemic volunteers from the community.

Intervention:

Low-carbohydrate diet (initially, <20 g of carbohydrate daily) plus nutritional supplementation, exercise recommendation, and group meetings, or low-fat diet (<30% energy from fat, <300 mg of cholesterol daily, and deficit of 500 to 1000 kcal/d) plus exercise recommendation and group meetings.

Measurements

Body weight, body composition, fasting serum lipid levels, and tolerability.

Results

A greater proportion of the low-carbohydrate diet group than the low-fat diet group completed the study (76% vs. 57%; P = 0.02). At 24 weeks, weight loss was greater in the low-carbohydrate diet group than in the low-fat diet group (mean change, -12.9% vs. -6.7%; P < 0.001). Patients in both groups lost substantially more fat mass (change, -9.4 kg with the low-carbohydrate diet vs. -4.8 kg with the low-fat diet) than fat-free mass (change, -3.3 kg vs. -2.4 kg, respectively). Compared with recipients of the low-fat diet, recipients of the low-carbohydrate diet had greater decreases in serum triglyceride levels (change, -0.84 mmol/L vs. -0.31 mmol/L [-74.2 mg/dL vs. -27.9 mg/dL]; P = 0.004) and greater increases in high-density lipoprotein cholesterol levels (0.14 mmol/L vs. -0.04 mmol/L [5.5 mg/dL vs. -1.6 mg/dL]; P < 0.001). Changes in low-density lipoprotein cholesterol level did not differ statistically (0.04 mmol/L [1.6 mg/dL] with the low-carbohydrate diet and -0.19 mmol/L [-7.4 mg/dL] with the low-fat diet; P = 0.2). Minor adverse effects were more frequent in the low-carbohydrate diet group.

Limitations

We could not definitively distinguish effects of the low-carbohydrate diet and those of the nutritional supplements provided only to that group. In addition, participants were healthy and were followed for only 24 weeks. These factors limit the generalizability of the study results.

Conclusions

Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet.