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JCI Insight. 2019 Jun 20;4(12). pii: 128308. doi: 10.1172/jci.insight.128308. eCollection 2019 Jun 20.

Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss.

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Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA.
Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland.
Davis Heart & Lung Research Institute, Department of Radiology; Department of Internal Medicine, Division of Cardiovascular Medicine; Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
Virta Health, San Francisco, California, USA.
Department of Atherosclerosis Research, Children's Hospital Oakland Research Institute, Oakland, California, USA.


BACKGROUNDMetabolic syndrome (MetS) is highly correlated with obesity and cardiovascular risk, but the importance of dietary carbohydrate independent of weight loss in MetS treatment remains controversial. Here, we test the theory that dietary carbohydrate intolerance (i.e., the inability to process carbohydrate in a healthy manner) rather than obesity per se is a fundamental feature of MetS.METHODSIndividuals who were obese with a diagnosis of MetS were fed three 4-week weight-maintenance diets that were low, moderate, and high in carbohydrate. Protein was constant and fat was exchanged isocalorically for carbohydrate across all diets.RESULTSDespite maintaining body mass, low-carbohydrate (LC) intake enhanced fat oxidation and was more effective in reversing MetS, especially high triglycerides, low HDL-C, and the small LDL subclass phenotype. Carbohydrate restriction also improved abnormal fatty acid composition, an emerging MetS feature. Despite containing 2.5 times more saturated fat than the high-carbohydrate diet, an LC diet decreased plasma total saturated fat and palmitoleate and increased arachidonate.CONCLUSIONConsistent with the perspective that MetS is a pathologic state that manifests as dietary carbohydrate intolerance, these results show that compared with eucaloric high-carbohydrate intake, LC/high-fat diets benefit MetS independent of whole-body or fat mass.TRIAL Identifier: NCT02918422.FUNDINGDairy Management Inc. and the Dutch Dairy Association.


Lipoproteins; Metabolism; Obesity

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