A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes

Background: Obesity, particularly visceral and ectopic adiposity, increases the risk of type 2 diabetes. Objective: The aim of this study was to determine if restriction of dietary carbohydrate is beneficial for body composition and metabolic health. Methods: Two studies were conducted. In the first, 69 overweight/obese men and women, 53% of whom were European American (EA) and 47% of whom were African American (AA), were provided with 1 of 2 diets (lower-fat diet: 55%, 18%, and 27% of energy from carbohydrate, protein, and fat, respectively; lower-carbohydrate diet: 43%, 18%, and 39%, respectively) for 8 wk at a eucaloric level and 8 wk at a hypocaloric level. In the second study, 30 women with polycystic ovary syndrome (PCOS) were provided with 2 diets (lower-fat diet: 55%, 18%, and 27% of energy from carbohydrate, protein, and fat, respectively; lower-carbohydrate diet: 41%, 19%, and 40%, respectively) at a eucaloric level for 8 wk in a random-order crossover design. Results: As previously reported, among overweight/obese adults, after the eucaloric phase, participants who consumed the lower-carbohydrate vs. the lower-fat diet lost more intra-abdominal adipose tissue (IAAT) (11 +/- 3% vs. 1 +/- 3%; P < 0.05). After weight loss, participants who consumed the lower-carbohydrate diet had 4.4% less total fat mass. Original to this report, across the entire 16-wk study, AAs lost more fat mass with a lower-carbohydrate diet (6 2 vs. 2.9 kg; P < 0.01), whereas EAs showed no difference between diets. As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (-2.8 mu IU/mL; P < 0.001) and fasting glucose (-47 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and dynamic beta-cell response (96.1 . 10(9); P < 0.001). In the lower-carbohydrate arm, women lost both IAAT (-4.8 cm(2), P < 0.01) and intermuscular fat (-1.2 cm(2); P < 0.01). In the lower-fat arm, women lost lean mass (-0.6 kg; P < 0.05). Original to this report, after the lower-carbohydrate arm, the change in IAAT was positively associated with the change in tumor necrosis factor a (P < 0.05). Conclusion: A modest reduction in dietary carbohydrate has beneficial effects on body composition, fat distribution, and glucose metabolism. This trial was registered at clinicaltrials.gov as NCT00726908 and NCT01028989.