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The possible advantage for weight loss of a diet that emphasizes protein, fat, or carbohydrates has not been established, and there are few studies that extend beyond 1 year.

67 kg weight loss as an effect of the level of protein or fat in the diet over the 2 year period, assuming a withdrawal rate of 40% 03 mmol per liter in men or less than 50 mg per deciliter 1.

They were informed that the study would be comparing diets with different fat, protein, and carbohydrate contents and that they would be assigned a diet at random. Dietary intake was assessed in a random sample of 50% of the participants, by a review of the 5 day diet record at baseline and by 24 hour recall during a telephone interview on 3 nonconsecutive days at 6 months and at 2 years. Major criteria for exclusion were the presence of diabetes or unstable cardiovascular disease, the use of medications that affect body weight, and insufficient motivation as assessed by interview and questionnaire.

Fasting blood samples, 24 hour urine samples, and measurement of resting metabolic rate were obtained on 1 day, and blood pressure measurement on 2 days, at baseline, 6 months, and 2 years. Staff and participants were taught that each diet adhered to principles of a healthful diet29. Participants were instructed to record their food and beverage intake in a daily food diary and in a web based self monitoring tool that provided information on how closely their daily food intake met the goals for macronutrients and energy.

69 mmol per liter or more, a high density lipoprotein hdl cholesterol level of less than 40 mg per deciliter mmol per liter in women, a blood pressure of mm hg or more, and a fasting glucose level of mg per deciliter 6. Body weight and waist circumference were measured in the morning before breakfast on 2 days at baseline, 6 months, and 2 years, and on a single day at 12 and 18 oup sessions were held once a week, 3 of every 4 weeks during the first 6 months and 2 of every 4 weeks from 6 months to 2 years; individual sessions were held every 8 weeks for the entire 2 years.

Study design and sites weight loss intervention. Daily meal plans in 2 week blocks were provided see the supplementary appendix participation in exercise was monitored by questionnaire30. Mass mailings were the primary means of recruitment; names were identified with the use of lists of registered voters or drivers.

We designed a randomized clinical trial to compare the effects on body weight of energy reduced diets that differed in their targets for intake of macronutrients low or high in fat, average or high in protein, or low or high in carbohydrates and otherwise followed recommendations for cardiovascular health. The goal for physical activity was 90 minutes of moderate exercise per week. The data coordinating center was at brigham and women s vestigators and staff who measured outcomes were unaware of the diet assignment of the participants.

1 mmol per liter or more. Participants had to be 30 to 70 years of age and have a body mass index the weight in kilograms divided by the square of the height in meters of 25 to 40.

Blinding was maintained by the use of similar foods for each diet. Were administered at baseline except for diet satisfaction and at 6 months and 2 years.

The trial was conducted at two sites: the harvard school of public health and brigham and women s hospital, boston; and the pennington biomedical research center of the louisiana state university system, baton rouge.

Each participant s caloric prescription represented a deficit of kcal per day from baseline, as calculated from the person s resting energy expenditure and activity level. Carbohydrate rich foods with a low glycemic index were recommended in each ntact among the groups was avoided.

We performed an intention to treat analysis in which long term weight loss for persons who withdrew from the study early after at least 6 months of participation was imputed on the basis of a rate of 0. The primary outcome of the study was the change in body weight over a period of 2 years, and the secondary outcome was the change in waist circumference. 3 cm per month of regained waist circumference after withdrawal see methods in the supplementary appendix random assignments to one of four diet groups were generated by the data manager at the coordinating center on request of a study dietitian, after eligibility of a participant was confirmed.

The project staff of the national heart, lung, and blood institute also participated in the development of the protocol, monitoring of progress, interpretation of results, and critical review of the manuscript. Blood pressure was measured with the use of an automated device hem 907xl, omron the trial was conducted from october through december the effects of protein, fat, and carbohydrate levels were evaluated independently with the use of two sample t tests at a two sided significance level of 0.

The study was powered to detect a 1. The participants were evaluated for the presence of the metabolic syndrome, which was defined by the presence of at least three of the following five criteria: waist circumference of more than cm in men or more than 88 cm in women, a triglyceride level of mg per deciliter 1.

The four diets also allowed for a dose– response test of carbohydrate intake that ranged from 35 to 65% of energy. The analysis also included a comparison of two of the four diets, the diet with the lowest carbohydrate content and the diet with the highest carbohydrate content, and included a test for trend across the four levels of carbohydrates.

Risk factors for cardiovascular disease and diabetes were also analyzed according to the intention to treat principle, with zero change from baseline imputed for missing data. The study was approved by the human subjects committee at each institution and by a data and safety monitoring board appointed by the national heart, lung, and blood havioral counseling was integrated into the group and individual sessions to promote adherence to the assigned diets. An expanded description of the methods is available in the supplementary appendix, available with the full text of this article at nejm.

And by the online self monitoring tool. And that each had been recommended for long term weight loss, thereby establishing equipoise. Thus, two diets were low fat and two were high fat, and two were average protein and two were high protein, constituting a two by two factorial design.

Can you lose weight by eating oatmeal everyday. Levels of serum lipids, glucose, insulin, and glycated hemoglobin were measured at the clinical laboratory at the pennington biomedical research center. Data were pooled from the diets for the two factorial comparisons: low fat versus high fat and average protein versus high protein.

All participants gave written informed consent. Questionnaires that asked for information on satiety, food craving, eating behavior, and satisfaction with the diet32, 33.

The nutrient goals for the four diet groups were: 20% fat, 15% protein, and 65% carbohydrates low fat, average protein 20% fat, 25% protein, and 55% carbohydrates low fat, high protein 40% fat, 15% protein, and 45% carbohydrates high fat, average protein and 40% fat, 25% protein, and 35% carbohydrates high fat, high protein associations between adherence to the fat and protein goals and weight loss were also explored in post hoc analyses see methods in the supplementary appendix 3 kg per month of regained weight34. Other goals for all groups were that the diets should include 8% or less of saturated fat, at least 20 g of dietary fiber per day, and mg or less of cholesterol per kcal. Exploratory post hoc analyses were performed with threshold amounts of weight loss as outcomes, with bonferroni s adjustment for multiple comparisons.

Our goal was to recruit overweight and obese subjects at each site of whom about 40% would be men.

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