"Kurt" <kurtwheeling1965@hotmail.com> wrote in message
news:1161037278.945544.326670@b28g2000cwb.googlegr oups.com...
> http://diabetes.org/diabetesnewsarti...althewEDIT.xml
>
> or
>
> http://tinyurl.com/yk786m
Hi Kurt,
not by the scientists the ADA sponsor themselves and with the typical
english under-statement they write :
"Despite the impressive features of this landmark study, the findings on
longterm weight change are somewhat underwhelming."
I can't blame them
A weight loss of 0.5 kg in 10 years ......
Most people would not stop laughing
Here is something to read for you :
Nutr Metab (Lond). 2005 Jul 14;2:16.
Comment in:
Nutr Metab (Lond). 2005 Aug 31;2:21.
The case for low carbohydrate diets in diabetes management.
Arora SK, McFarlane SI.
Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate Medical
Center, Kings County Hospital Center, Brooklyn, NY 11203, USA.
surenderkarora@yahoo.com
A low fat, high carbohydrate diet in combination with regular exercise is
the traditional recommendation for treating diabetes. Compliance with these
lifestyle modifications is less than satisfactory, however, and a high
carbohydrate diet raises postprandial plasma glucose and
insulin secretion,
thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and
diabetes. Moreover, the current epidemic of diabetes and obesity has been,
over the past three decades, accompanied by a significant decrease in fat
consumption and an increase in carbohydrate consumption. This apparent
failure of the traditional diet, from a public health point of view,
indicates that alternative dietary approaches are needed. Because
carbohydrate is the major secretagogue of insulin, some form of carbohydrate
restriction is a prima facie candidate for dietary control of diabetes.
Evidence from various randomized controlled trials in recent years has
convinced us that such diets are safe and effective, at least in short-term.
These data show low carbohydrate diets to be comparable or better than
traditional low fat high carbohydrate diets for weight reduction,
improvement in the dyslipidemia of diabetes and metabolic syndrome as well
as control of blood pressure, postprandial glycemia and insulin secretion.
Furthermore, the ability of low carbohydrate diets to reduce triglycerides
and to increase HDL is of particular importance. Resistance to such
strategies has been due, in part, to equating it with the popular Atkins
diet. However, there are many variations and room for individual physician
planning. Some form of low carbohydrate diet, in combination with exercise,
is a viable option for patients with diabetes. However, the extreme
reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended
for a diabetic population at this time without further study. On the other
hand, the dire objections continually raised in the literature appear to
have very little scientific basis. Whereas it is traditional to say that
more work needs to be done, the same is true of the assumed standard low fat
diets which have an ambiguous record at best. We see current trends in the
national dietary recommendations as a positive sign and an appropriate move
in the right direction.
PMID: 16018812
JAMA. 2006 Jan 4;295(1):39-49.
Comment in:
JAMA. 2006 Jan 4;295(1):94-5.
JAMA. 2006 Jul 26;296(4):394; author reply 394-5.
Low-fat dietary pattern and weight change over 7 years: the Women's Health
Initiative Dietary Modification Trial.
Howard BV, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B,
Rodabough RJ, Snetselaar L, Thomson C, Tinker L, Vitolins M, Prentice R.
MedStar Research Institute, Washington, DC, USA.
Barbara.V.Howard@MedStar.net
CONTEXT: Obesity in the United States has increased dramatically during the
past several decades. There is debate about optimum calorie balance for
prevention of weight gain, and proponents of some low-carbohydrate diet
regimens have suggested that the increasing obesity may be attributed, in
part, to low-fat, high-carbohydrate diets. OBJECTIVES: To report data on
body weight in a long-term, low-fat diet trial for which the primary end
points were breast and colorectal cancer and to examine the relationships
between weight changes and changes in dietary components. DESIGN, SETTING,
AND PARTICIPANTS: Randomized intervention trial of 48,835 postmenopausal
women in the United States who were of diverse backgrounds and ethnicities
and participated in the Women's Health Initiative Dietary Modification
Trial; 40% (19,541) were randomized to the intervention and 60% (29,294) to
a control group. Study enrollment was between 1993 and 1998, and this
analysis includes a mean follow-up of 7.5 years (through August 31, 2004).
INTERVENTIONS: The intervention included group and individual sessions to
promote a decrease in fat intake and increases in vegetable, fruit, and
grain consumption and did not include weight loss or caloric restriction
goals. The control group received diet-related education materials. MAIN
OUTCOME MEASURE: Change in body weight from baseline to follow-up. RESULTS:
Women in the intervention group lost weight in the first year (mean of 2.2
kg, P<.001) and maintained lower weight than control women during an average
7.5 years of follow-up (difference, 1.9 kg, P<.001 at 1 year and 0.4 kg, P =
..01 at 7.5 years). No tendency toward weight gain was observed in
intervention group women overall or when stratified by age, ethnicity, or
body mass index. Weight loss was greatest among women in either group who
decreased their percentage of energy from fat. A similar but lesser trend
was observed with increases in vegetable and fruit servings, and a
nonsignificant trend toward weight loss occurred with increasing intake of
fiber. CONCLUSION: A low-fat eating pattern does not result in weight gain
in postmenopausal women.Clinical Trial Registration ClinicalTrials.gov,
NCT00000611.
Publication Types:
Randomized Controlled Trial
MeSH Terms:
Aged
Anthropometry
Diet Records
Diet, Fat-Restricted*
Female
Follow-Up Studies
Humans
Middle Aged
Postmenopause
Research Support, N.I.H., Extramural
Weight Loss*
Secondary Source ID:
ClinicalTrials.gov/NCT00000611
PMID: 16391215
Oh and don't forget to read the editorial comment in the same issue of
JAMA. 2006 Jan 4;295(1):39-49 :
Low-Fat Diets and Weight Change
Michael L. Dansinger, MD, MS
Ernst J. Schaefer, MD
THE ARTICLE BY HOWARD AND COLLEAGUES1 IN THIS
issue of JAMA, which reports on the largest, most
ambitious randomized dietary intervention trial
conducted to date, has concluded that a low-fat diet
program does not produce weight gain.1 Despite the impressive
features of this landmark study, the findings on longterm
weight change are somewhat underwhelming.
The Women's Health Initiative (WHI),2 of which the Dietary
Modification Trial is one component,3 is one of the
most outstanding achievements in clinical research history.
The National Institutes of Health established the WHI
in 1991 to address the most common causes of death, disability,
and impaired quality of life in postmenopausal
women. This multimillion-dollar, 15-year project, involving
161 808 women aged 50 through 79 years, was designed
to address many of the inequities in women's health
research and provide practical information to women and
their physicians about hormone therapy, calcium/vitamin
Dsupplements, dietary patterns, and prevention of heart disease,
cancer, and osteoporosis.
The Dietary Modification Trial component evaluated the
effect of a low-fat (target 20% fat), high-fruit/vegetable and
grain diet on the prevention of breast and colorectal cancer
and heart disease. Between 1993 and 1998, 48 835 postmenopausal
women with a mean baseline age of 62.3 years, mean
body mass index of 29.1, and a dietary fat intake of at least
32% of total calories (approximately the 50th percentile for
fat intake) were randomly assigned to either the self-selected
dietary control group or the low-fat dietary intervention, which
aimed to change dietary patterns but did not encourage weight
loss or caloric reduction (even though the vast majority of participants
were obese or overweight). The trial did provide a
unique opportunity to examine long-term effects of an ad libitum
low-fat dietary pattern on body weight and the relationships
between weight changes and specific changes in dietary
components. The authors reported a 2.2-kg weight loss in the
intervention group at year 1 (1.9 kg between groups) and a
modest 0.4-kg difference between the groups at the 7.5-year
mark (P=.01). They concluded that a low-fat eating pattern
does not result in weight gain in postmenopausal women.1
The article by Howard et al1 is quick to focus attention on
popular diets such as Atkins,4 the Zone,5 and Sugar Busters!,6
whose authors have blamed the current obesity epidemic in
large part on the low-fat (high-carbohydrate) eating pattern
advocated by most authorities during much of the past quarter
century.7,8 Does the recent study refute allegations that the
low-fat dietary approach caused weight gain on a national scale?
Perhaps it does to some extent. On the other hand, despite
some successes,9-12 overall the low-fat dietary approach has been
a failure with the US public, which is in desperate need of effective
obesity treatment and prevention strategies.
Did the WHI trial designers miss an opportunity to choose
a better dietary intervention? Should they have encouraged
specific caloric reductions in overweight and obese
women? The intervention group reported a significant reduction
in total fat intake of 9 percentage points (38.8% to
29.8% of calories as measured by food frequency questionnaire)
with little or no change in the control group, suggesting
a rather successful dietary intervention (although
not close to the 20% target). But even though the women
who reduced fat intake the most maintained some modest
weight loss, absent an explicitly targeted caloric reduction
this approach apparently had very little effect on mean body
weight long term and presumably little effect on caloric intake.
Given what was known about nutrition at study inception,
the low-fat, high-fruit/vegetable and grain diet seems
to have been a straightforward choice. The same cannot necessarily
be said for the absent caloric restriction advice for
overweight and obese participants. Weight loss was not a
treatment goal, but perhaps it should have been.
Is it time to admit defeat? Is US society doomed to be one
in which few individuals maintain normal body weight and
one third of adults are obese?13 This study by Howard et al1
does little to reassure skeptics, and some see no hope on the
horizon. Many believe humankind does not have the selfcontrol
to counterbalance the forces that create a predictable
wave of obesity in technologically advancing societies.
Some believe national governments will never enact the bold
policy changes that could make a dent in the obesity rates,
such as substantially altering food advertising practices and
creating economic incentives for vigorous adherence to lifestyle
recommendations. Even modest steps such as limiting
advertising of unhealthy food during children's television programming
or placing small taxes on unhealthy foods are met
hth
Gys
Whole Grains Cut Diabetes Risk For Black Women 
Linear Mode
