Abstract

The aim of this study was to determine after 52 weeks whether advice to follow a lower carbohydrate diet, either high in monounsaturated fat or low fat, high in protein had differential effects in a free-living community setting. Following weight loss on either a high monounsaturated fat, standard protein (HMF; 50 % fat, 20 % protein (67 g/d), 30 % carbohydrate) or a high protein, moderate fat (HP) (40 % protein (136 g/d), 30 % fat, 30 % carbohydrate) energy-restricted diet (6000 kJ/d) subjects were asked to maintain the same dietary pattern without intensive dietary counselling for the following 36 weeks. Overall weight loss was 6.2 (SD 7.3) kg (P < 0.01 for time with no diet effect, 7.6 (SD 8.1) kg, HMF v. 4.8 (SD 6.6) kg, HP). In a multivariate regression model predictors of weight loss at the end of the study were sex, age and reported percentage energy from protein (R2 0.22, P < 0.05 for the whole model). Fasting plasma insulin decreased (P < 0.01, with no difference between diets), 13.9 (SD 4.6) to 10.2 (SD 5.2) mIU/l, but fasting plasma glucose was not reduced. Neither total cholesterol nor LDL-cholesterol were different but HDL was higher, 1.19 (SD 0.26) v. 1.04 (SD 0.29) (P < 0.001 for time, no diet effect), while TAG was lower, 1.87 (SD 1.23) v. 2.22 (SD 1.15) mmol/l (P < 0.05 for time, no diet effect). C-reactive protein decreased (3.97 (SD 2.84) to 2.43 (SD 2.29) mg/l, P < 0.01). Food records showed that compliance to the prescribed dietary patterns was poor. After 1 year there remained a clinically significant weight loss and improvement in cardiovascular risk factors with no adverse effects of a high monounsaturated fat diet.