http://archinte.ama-assn.org/cgi/content/short/164/19/2141

The National Cholesterol Education Program Diet vs a Diet Lower in
Carbohydrates and Higher in Protein and Monounsaturated Fat
A Randomized Trial

Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD,
MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP;
Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD,
DrPH

Arch Intern Med. 2004;164:2141-2146.

Background  In the United States, obesity is a major clinical and
public health problem causing diabetes, dyslipidemia, and
hypertension, as well as increasing cardiovascular and total
mortality. Dietary restrictions of calories and saturated fat are
beneficial. However, it remains unclear whether replacement of
saturated fat with carbohydrates (as in the US National Cholesterol
Education Program [NCEP] diet) or protein and monounsaturated fat (as
in our isocaloric modified low-carbohydrate [MLC] diet, which is lower
in total carbohydrates but higher in protein, monounsaturated fat, and
complex carbohydrates) is optimal.

Methods  We randomized 60 participants (29 women and 31 men) to the
NCEP or the MLC diet and evaluated them every 2 weeks for 12 weeks.
They were aged 28 to 71 years (mean age, 44 years in the NCEP and 46
years in the MLC group). A total of 36% of participants from the NCEP
group and 35% from the MLC group had a body mass index (calculated as
weight in kilograms divided by the square of height in meters) greater
than 27. The primary end point was weight loss, and secondary end
points were blood lipid levels and waist-to-hip ratio.

Results  Weight loss was significantly greater in the MLC (13.6 lb)
than in the NCEP group (7.5 lb), a difference of 6.1 lb (P = .02).
There were no significant differences between the groups for total,
low density, and high-density lipoprotein cholesterol, triglycerides,
or the proportion of small, dense low-density lipoprotein particles.
There were significantly favorable changes in all lipid levels within
the MLC but not within the NCEP group. Waist-to-hip ratio was not
significantly reduced between the groups (P = .27), but it
significantly decreased within the MLC group (P = .009).

Conclusions  Compared with the NCEP diet, the MLC diet, which is lower
in total carbohydrates but higher in complex carbohydrates, protein,
and monounsaturated fat, caused significantly greater weight loss over
12 weeks. There were no significant differences between the groups in
blood lipid levels, but favorable changes were observed within the MLC
diet group.

Author Affiliations: Agatston Research Institute (Drs Aude, Agatston,
and Hennekens and Ms Almon); the Division of Cardiovascular Research,
Mount Sinai Medical Center–Miami Heart Institute (Drs Aude,
Lopez-Jimenez, Lieberman, Rojas, and Lamas, and Ms Hansen); and the
Departments of Medicine (Drs Agatston, Lamas, and Hennekens) and
Epidemiology and Public Health (Dr Hennekens), University of Miami
School of Medicine, Miami Beach, Fla.

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TC