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Frontiers of Medicine

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Front. Med.    2021, Vol. 15 Issue (3) : 460-471    https://doi.org/10.1007/s11684-021-0861-6
RESEARCH ARTICLE
Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: a randomized clinical trial
Lingli Cai, Jun Yin, Xiaojing Ma, Yifei Mo, Cheng Li, Wei Lu, Yuqian Bao, Jian Zhou(), Weiping Jia()
Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
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Abstract

Lifestyle interventions, including dietary adjustments and exercise, are important for obesity management. This study enrolled adults with overweight or obesity to explore whether either low-carbohydrate diet (LCD) or exercise is more effective in metabolism improvement. Forty-five eligible subjects were randomly divided into an LCD group (n=22) and an exercise group (EX, n=23). The subjects either adopted LCD (carbohydrate intake<50 g/day) or performed moderate-to-vigorous exercise (≥30 min/day) for 3 weeks. After the interventions, LCD led to a larger weight loss than EX (−3.56±0.37 kg vs. −1.24±0.39 kg, P<0.001), as well as a larger reduction in fat mass (−2.10±0.18 kg vs. −1.25±0.24 kg, P=0.007) and waist circumference (−5.25±0.52 cm vs. −3.45±0.38 cm, P=0.008). Both interventions reduced visceral and subcutaneous fat and improved liver steatosis and insulin resistance. Triglycerides decreased in both two groups, whereas low-density lipoprotein cholesterol increased in the LCD group but decreased in the EX group. Various glycemic parameters, including serum glycated albumin, mean sensor glucose, coefficient of variability (CV), and largest amplitude of glycemic excursions, substantially declined in the LCD group. Only CV slightly decreased after exercise. This pilot study suggested that the effects of LCD and exercise are similar in alleviating liver steatosis and insulin resistance. Compared with exercise, LCD might be more efficient for weight loss and glucose homeostasis in people with obesity.
Keywords low-carbohydrate diet      obesity      nonalcoholic fatty liver disease      continuous glucose monitoring      mean sensor glucose     
Corresponding Author(s): Jian Zhou,Weiping Jia   
Just Accepted Date: 13 May 2021   Online First Date: 01 June 2021    Issue Date: 18 June 2021
 Cite this article:   
Lingli Cai,Jun Yin,Xiaojing Ma, et al. Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: a randomized clinical trial[J]. Front. Med., 2021, 15(3): 460-471.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0861-6
https://academic.hep.com.cn/fmd/EN/Y2021/V15/I3/460
Fig.1  Study design schematic. 2hPG, 2-h plasma glucose; CGM, continuous glucose monitoring; EX, exercise group; FINS, fasting serum insulin; FPG, fasting plasma glucose; GA, serum glycated albumin; H, hip circumference; HbA1c, glycated hemoglobin A1c; LCD, low-carbohydrate diet group; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; OGTT, oral glucose tolerance test; T, thigh circumference; W, waist circumference.
Fig.2  Flowchart of subject recruitment.
Parameters LCD (n = 22) EX (n = 22) P value
Baseline Endpoint Change Baseline Endpoint Change
Age (year) 25.36±0.75 / / 24.27±0.43 / / /
Male/female 13/9 / / 16/6 / / /
Weight (kg) 83.76±3.18 80.20±3.05 −3.56±0.37 80.62±2.75 79.38±2.52 −1.24±0.39 <0.001
BMI (kg/m2) 27.85±0.75 26.68±0.75 −1.17±0.11 27.33±0.69 26.92±0.61 −0.41±0.13 <0.001
W (cm) 96.00±2.39 90.75±2.23 −5.25±0.52 94.59±1.87 91.14±1.77 −3.45±0.38 0.008
H (cm) 108.77±1.30 107.07±1.31 −1.70±0.51 107.82±1.21 106.00±1.15 −1.18±0.36 0.409
T (cm) 60.18±0.96 58.64±0.92 −1.55±0.32 58.93±0.91 57.68±0.81 −1.25±0.28 0.497
WHR 0.881±0.013 0. 846±0.013 −0.035±0.004 0.882±0.010 0.859±0.049 −0.023±0.004 0.036
VFA (cm2) 50.26±5.66 42.40±5.40 −7.87±1.22 48.18±4.08 37.82±3.41 −10.36±1.81 0.258
SFA (cm2) 286.08±20.87 262.91±22.52 −23.17±4.34 253.54±17.83 230.75±18.27 −22.79±5.78 0.959
FPG (mmol/L) 5.04±0.09 4.98±0.09 −0.06±0.13 5.08±0.12 5.07±0.13 −0.01±0.08 0.771
2hPG (mmol/L) 6.02±0.44 / / 5.98±0.28 / / /
FINS (μU/mL) 13.88±1.36 10.04±0.90 −3.84±0.98 16.41±1.98 11.60±1.36 −4.81±1.61 0.610
HOMA-IR 3.13±0.32 2.24±0.21 −0.89±0.22 3.79±0.51 2.69±0.36 −1.10±0.38 0.633
HbA1c (%) 5.30±0.06 5.28±0.05 −0.01±0.04 5.25±0.07 5.25±0.07 0.01±0.04 0.669
GA (%) 12.16±0.25 11.61±0.24 −0.55±0.17 12.21±0.15 12.18±0.20 −0.03±0.15 0.027
TC (mmol/L) 4.67±0.22 4.85±0.24 0.18±0.15 4.72±0.14 4.46±0.14 −0.26±0.10 0.023
TG (mmol/L) 1.16±0.13 0.81±0.12 −0.35±0.13 1.10±0.10 0.87±0.05 −0.23±0.10 0.480
HDL-c (mmol/L) 1.23±0.08 1.30±0.08 0.07±0.04 1.14±0.05 1.23±0.06 0.09±0.06 0.874
LDL-c (mmol/L) 2.68±0.19 2.97±0.21 0.29±0.12 2.95±0.14 2.71±0.14 −0.24±0.11 0.002
Tab.1  Anthropometric and biochemical assessments before and after the 3-week intervention
Fig.3  (A) Comparison of ?body weight during the study and changes of body composition including (B) ?Total body, (C) ?Trunk and (D) ?Limbs between the LCD (n = 22) and the EX (n = 22) groups. Data are reported as mean±SEM. **P<0.01, *** P<0.001.
Fig.4  (A) ?FPG, (B) ?FINS, and (C) ?HOMA-IR of the LCD group (n = 22) and the EX group (n = 22) during the study. Data are reported as mean±SEM. *P<0.05 compared with LCD.
Fig.5  (A) Trend of IHTC and (B) changes in IHTC in the subjects with NAFLD pre- and post-intervention in the LCD group (n = 12) and the EX group (n = 8). Data are reported as mean±SEM. *P<0.05, ***P<0.001.
Parameters LCD (n = 22) EX (n = 22) P value
Baseline Endpoint Change Baseline Endpoint Change
ALT (U/L) 24.50±3.78 17.23±2.57 −7.27±2.66 29.73±5.23 23.00±3.85 −6.73±2.70 0.886
AST (U/L) 19.86±1.56 18.91±1.50 −0.95±1.55 22.14±2.48 22.00±2.94 −0.14±2.76 0.797
AKP (U/L) 56.27±2.45 49.68±2.61 −6.59±1.84 57.86±2.51 58.09±3.58 0.23±1.65 0.009
γ-GT (U/L) 29.55±3.90 19.23±2.10 −10.32±2.22 30.00±3.73 23.68±2.67 −6.32±2.16 0.203
TP (g/L) 73.91±0.71 75.09±0.72 1.18±0.62 73.91±0.81 72.91±0.76 −1.00±0.51 0.009
ALB (g/L) 48.68±0.59 50.18±0.44 1.50±0.50 49.09±0.53 49.23±0.53 0.14±0.42 0.044
ALB/GLB 1.95±0.05 2.05±0.06 0.10±0.03 1.99±0.04 2.10±0.04 0.11±0.04 0.994
PALB (mg/L) 307.82±11.29 265.14±11.71 −42.68±7.70 314.73±11.35 288.86±13.71 −25.86±9.68 0.181
IHTC (%) 11.90±3.08 8.67±2.72 −3.23±0.78 10.80±3.28 7.50±2.69 −3.31±1.30 0.960
Tab.2  Liver function and intrahepatic triglyceride content before and after the 3-week intervention
Fig.6  (A) MSG curves, comparison of (B) 24 h MSG level, (C) daytime and nighttime MSG levels between the LCD group (n = 16) and the EX group (n = 16). Data are reported as mean±SEM. **P<0.01, ***P<0.001 compared with LCD; ##P<0.01, ###P<0.001 compared with day 0; !!!P<0.001 compared with day 22. Average, mean value of the whole intervention time.
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