Several popular diets that emphasize low-fat, low-carbohydrate, and moderate-macronutrient eating patterns are associated with moderate weight reduction and reductions in systolic and diastolic blood pressure at six months, according to a meta-analysis.
Their research is aligned with the growing body of literature on diets to support weight loss and related cardioprotective benefits.
Compared to the regular diet, low-carb diets like Atkins and Zone, and low-fat diets like Ornish, had a similar effect at six months on weight loss (4.63 v 4.37 kg, both with moderate certainty) , reduction of systolic blood pressure (5.14 mm Hg, moderate certainty v 5.05 mm Hg, low certainty) and reduction of diastolic blood pressure (3.21 v 2.85 mm Hg, both low certainty).
The study also found that moderate macronutrient diets like DASH resulted in slightly less weight loss and smaller reductions in blood pressure.
Low carbohydrate diets had less effect than low fat diets and moderate macronutrient diets in reducing LDL cholesterol (1.01 mg / dL, low certainty v 7.08 mg / dL, moderate certainty v 5.22 mg / dL, moderate certainty , respectively), but low carbohydrate diets were also associated with an increase in HDL cholesterol (2.31 mg / dL, low certainty).
Among the popularly named diets, those with the greatest effect on weight reduction and blood pressure compared to the usual diet were Atkins (weight 5.5 kg, systolic blood pressure 5.1 mm Hg, diastolic blood pressure 3, 3 mm Hg), DASH (3.6 kg, 4.7 mm Hg, 2.9 mm Hg, respectively), and Zone (4.1 kg, 3.5 mm Hg, 2.3 mm Hg, respectively) at six months (all with moderate certainty ).
No diet significantly improved HDL cholesterol or C-reactive protein levels at six months.
Overall, weight loss decreased at 12 months across all macronutrient patterns and popular named diets, while the cardiovascular risk factor benefits of all interventions except the Mediterranean diet essentially disappeared.
While the Mediterranean diet is beneficial, at 12 months follow-up, it even had very limited evidence of efficacy.
This suggests that doctors should encourage patients to follow most diets if it is sustainable for their lifestyle, but that it might make sense to switch to a different healthy diet if the former does not help patients achieve their goals.
Given the difficulty with long-term adherence, doctors may even encourage overweight patients to switch between the most effective diets.
A limitation of the study is that many comparisons provided low-certainty evidence primarily because of inconsistency and imprecision, but also because of the risk of bias, the study authors write in The BMJ.
Another is that many smaller trials included in the analysis did not report specific results at 12 months, and most of the evidence was low or very low certainty.
Diet adherence was also not reported in most trials, and macronutrients were determined based on the general characteristics of different popular diets and not based on measures of food intake or macronutrient intake of the individual participants.
Doctors and patients need to be careful about reading these results too much.
Adults tend to have maximum weight loss after 10-12 weeks when they reduce their energy intake and after the weight loss decreases and can stabilize.
Most popular diets do not include information and advice needed to extend the weight loss phase or provide information on how to maintain weight after losing that initial weight.
This is a gap in what is provided and people often need much more support after the first 6 months to maintain that weight loss.
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