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Title: Energy requirement is higher during weight-loss maintenance in adults consuming a low-compared with high-carbohydrate diet

Author
item EBBELING, CARA - Boston Children'S Hospital
item BIELAK, LISA - Boston Children'S Hospital
item LAKIN, PAUL - Boston Children'S Hospital
item KLEIN, GLORIA - Boston Children'S Hospital
item WONG, JULIA - Boston Children'S Hospital
item LUOTO, PATRICIA - Framingham State College
item WONG, WILLIAM - Children'S Nutrition Research Center (CNRC)
item LUDWIG, DAVID - Boston Children'S Hospital

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/4/2020
Publication Date: 5/29/2020
Citation: Ebbeling, C.B., Bielak, L., Lakin, P.R., Klein, G.L., Wong, J.M., Luoto, P.K., Wong, W.W., Ludwig, D.S. 2020. Energy requirement is higher during weight-loss maintenance in adults consuming a low-compared with high-carbohydrate diet. Journal of Nutrition. 150(8):2009-2015. https://doi.org/10.1093/jn/nxaa150.
DOI: https://doi.org/10.1093/jn/nxaa150

Interpretive Summary: Diets with high amounts of sugars, pasta, and grain products are linked to an increase in unhealthy body weight. Weight loss by diet might be effective but keeping the amount of weight loss over time is difficult. Diets with low content of sugars, pasta, and grain products might increase calories used by the body and depress appetite and therefore might prevent weight regain. To test this idea, we enrolled adults between 18 and 65 years of age into a study. After these adults lost about 12% of body weight on a control diet, they were divided into three groups and mainted a diet for 20 weeks. The first group stayed on a diet made up with 60% of sugars, pasta, and grain products. The second group stayed on a diet made up with 40% of sugars, pasta, and grain products. The third group were fed a diet made up with 20% of sugars, pasta, and grain products. All three diets contained the same amount of protein while making changes on the calorie of the diets to keep the body weight within 4.5 lb over the 20-week period. At the end of the 20-week feeding study and based on the actual weights of the meals and snacks consumed, the energy requirement was the highest among the adults who were fed the diet with the lowest amount (20%) of sugars, pasta, and grain products thus supporting our earlier report showing that these same adults burned the most calories. Adults fed the diet with the highest amount (60%) of sugars, pasta, and grain products had the lowest energy requirement and in agreement with our earlier report that these same adults burned the least amount of calories. Therefore, our study showed that a diet with a low amount of sugars, pasta, and grain products might help to prevent weight regain in a weight loss program.

Technical Abstract: Longer-term feeding studies suggest that a low-carbohydrate diet increases energy expenditure, consistent with the carbohydrate-insulin model of obesity. However, the validity of methodology utilized in these studies, involving doubly labeled water (DLW), has been questioned. The aim of this study was to determine whether dietary energy requirement for weight-loss maintenance is higher on a low- compared with high-carbohydrate diet. The study reports secondary outcomes from a feeding study in which the primary outcome was total energy expenditure (TEE). After attaining a mean Run-in weight loss of 10.5%, 164 adults (BMI >/-25 kg/m2; 70.1% women) were randomly assigned to Low-Carbohydrate (percentage of total energy from carbohydrate, fat, protein: 20/60/20), Moderate-Carbohydrate (40/40/20), or High-Carbohydrate (60/20/20) Test diets for 20 wk. Calorie content was adjusted to maintain individual body weight within +/- 2 kg of the postweight-loss value. In analyses by intention-to-treat (ITT, completers, n = 148) and per protocol (PP, completers also achieving weight-loss maintenance, n = 110), we compared the estimated energy requirement (EER) from 10 to 20 wk of the Test diets using ANCOVA. Mean EER was higher in the Low- versus High-Carbohydrate group in models of varying covariate structure involving ITT [ranging from 181 (95% CI: 8–353) to 246 (64–427) kcal/d; P