Association of dietary adherence and dietary quality with weight loss success among those following low-carbohydrate and low-fat diets: a secondary analysis of the DIETFITS randomized clinical trial.

Michelle E Hauser, Jennifer C Hartle, Matthew J Landry, Priya Fielding-Singh, Cynthia W Shih, FeiFei Qin, Joseph Rigdon, Christopher D Gardner

Journal: The American journal of clinical nutrition 2024;119(1):174-184

PMID: 37931749

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Abstract

BACKGROUND

Eating a high-quality diet or adhering to a given dietary strategy may influence weight loss. However, these 2 factors have not been examined concurrently for those following macronutrient-limiting diets.

OBJECTIVE

To determine whether improvement in dietary quality, change in dietary macronutrient composition, or the combination of these factors is associated with differential weight loss when following a healthy low-carbohydrate (HLC) or healthy low-fat (HLF) diet.

DESIGN

Generally healthy adults were randomly assigned to HLC or HLF diets for 12 mo (n = 609) as part of a randomized controlled weight loss study. Participants with complete 24-h dietary recall data at baseline and 12-mo were included in this secondary analysis (total N = 448; N = 224 HLC, N = 224 HLF). Participants were divided into 4 subgroups according to 12-mo change in HEI-2010 score [above median = high quality (HQ) and below median = low quality (LQ)] and 12-mo change in macronutrient intake [below median = high adherence (HA) and above median = low adherence (LA) for net carbohydrate (g) or fat (g) for HLC and HLF, respectively]. Baseline to 12-mo changes in mean BMI were compared for those in HQ/HA, HQ/LA, LQ/HA subgroups with the LQ/LA subgroup within HLC and HLF.

RESULTS

For HLC, changes (95 % confidence level [CI]) in mean BMI were -1.15 kg/m (-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup. For HLF, changes (95% CI) in mean BMI were -1.11kg/m (-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup.

CONCLUSION

Within both HLC and HLF diet arms, 12-mo decrease in BMI was significantly greater in HQ/HA subgroups relative to LQ/LA subgroups. Neither HQ nor HA alone were significantly different than LQ/LA subgroups. Results of this analysis support the combination of dietary adherence and high-quality diets for weight loss.

CLINICAL TRIAL REGISTRY

clinicaltrials.gov (Identifier: NCT01826591).

Address: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States; Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States; Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States; Internal Medicine-Obesity Medicine, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, United States.; Department of Public Health and Recreation, San José State University, San José, CA, United States.; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.; Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States.; Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford CA, United States.; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States.; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States. Electronic address: [email protected].

DOI: 10.1016/j.ajcnut.2023.10.028

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MeSH Terms: Adult, Humans, Diet, Fat-Restricted, Diet, Reducing, Weight Loss, Carbohydrates