The effect of three different ad libitum diets for weight loss maintenance: a randomized 18-month trial
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To test the effect of three diets in their ability to sustain weight loss and improve type 2 diabetes (T2D) and cardiovascular disease (CVD) risk markers after 18-month intervention.
Following a ≥8 % weight loss, 131 healthy, overweight/obese (BMI ± SD 31.5 ± 2.6 kg/m2) men (n = 55) and women (n = 76) aged 28.2 ± 4.8 years were randomized to either 1. Moderate fat (40 E%) with 20 E% MUFA and low in glycemic index (GI) (MUFA, n = 54), 2. Low fat (25 E%) and medium in GI (LF, n = 51) or 3. Control (35 E% fat) and high in GI (CTR, n = 26) all with similar protein content, and all provided ad libitum. First 6-month intervention with 100 % food provision (previously reported) following 12 months of moderately intensive intervention with 20 % food provision now reported.
Attrition rate was higher in MUFA (63 %) than in LF (37 %, P = 0.019) and CTR (42 %, P = 0.09) group. Weight regain in completers was not different between groups (mean ± SEM), MUFA 7.1 ± 2.1 % versus LF 5.6 ± 1.3 % versus CTR 7.2 ± 1.5 %, nor was body fat regain, MUFA 4.8 ± 1.0 % versus LF 4.7 ± 0.8 % versus CTR 5.7 ± 0.6 %. The MUFA group reduced LDL/HDL ratio by −0.47 ± 0.09 compared with −0.23 ± 0.11 in LF (P < 0.05) and 0.06 ± 0.14 (P < 0.005) in CTR groups.
Weight regain or body composition did not differ between diets over 18 months. No effects on risk markers for T2D or CVD were found, with the exception of an improvement in the LDL/HDL ratio by the MUFA diet compared to the CTR diet. The LF diet was generally more satisfactory and the MUFA diet seemed more difficult to follow.
KeywordsWeight loss Weight maintenance Mediterranean diet Cardiovascular disease Dietary intervention
The authors wish to thank the project staff of the Department of Human Nutrition. Special thanks to Professor Walter Willett, Department of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA, and David Ludwig MD, PhD, Department of Medicine, Children’s Hospital, Boston, Massachusetts, USA, for participating in the design of the project and Miguel Padilla, PhD, Department of Biostatistics, University of Alabama at Birmingham, USA, for the ITT analysis.
This research was supported by foundations, associations, and research councils (e.g. H.A. Foundation, The Danish Heart Association, The Danish Diabetes Association, Centre for Advanced Food Research, The state Research Councils, The Danish Pork Council foundations). Effort for David B Allison was supported by P3ODK056336. Most of the foods in the supermarket (80 %) and the low-calorie diets were sponsored by the food industry. No sponsor participated in the analysis or interpretation of the data, manuscript preparation, review, or approval, or the decision to publish.
Due had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Astrup, Larsen, Toubro, and Due are involved in study concept and design. Due and Larsen are involved in acquisition of data. Due, Larsen, Mu, Hermansen, Stender, Toubro, Allison, and Astrup analysed and interpreted the data. Due drafted the manuscript. Due, Larsen, Mu, Hermansen, Stender, Toubro, Allison, and Astrup contributed to the critical revision of the manuscript for important intellectual content. Due and Allison are involved in statistical analysis. Astrup, Larsen and Due obtained funding. Due, Larsen, Mu, Hermansen, Stender, and Astrup provided administrative, technical, or material support. Astrup supervised the study. All listed authors have contributed significantly to the manuscript and given their consent for publication. None of the listed authors have conflicting interests that might affect the outcome of this research.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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