Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study

Abstract

OBJECTIVE: To investigate the long-term effects of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates.

DESIGN: Randomized controlled multicentre trial (CARMEN), in which subjects were allocated for 6 months either to a seasonal control group (no intervention) or to one of three experimental groups: a control diet group (dietary intervention typical of the average national intake); a low-fat high simple carbohydrate group; or a low-fat high complex carbohydrate group.

SUBJECTS: Three hundred and ninety eight moderately obese adults.

MEASUREMENTS: The change in body weight was the primary outcome; changes in body composition and blood lipids were secondary outcomes.

RESULTS: Body weight loss in the low-fat high simple carbohydrate and low-fat high complex carbohydrate groups was 0.9 kg (P<0.05) and 1.8 kg (P<0.001), while the control diet and seasonal control groups gained weight (0.8 and 0.1 kg, NS). Fat mass changed by−1.3 kg (P<0.01),−1.8 kg (P<0.001) and+0.6 kg (NS) in the low-fat high simple carbohydrate, low-fat high complex carbohydrate and control diet groups, respectively. Changes in blood lipids did not differ significantly between the dietary treatment groups.

CONCLUSION: Our findings suggest that reduction of fat intake results in a modest but significant reduction in body weight and body fatness. The concomitant increase in either simple or complex carbohydrates did not indicate significant differences in weight change. No adverse effects on blood lipids were observed. These findings underline the importance of this dietary change and its potential impact on the public health implications of obesity.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. World Health Organisation . Obesity: preventing and managing the global epidemic WHO: Geneva 1998.

  2. Poppitt SD . Energy density of diets and obesity Int J Obes Relat Metab Disord 1995 19 (Suppl): S20–S26.

    PubMed  Google Scholar 

  3. Katan MB, Grundy SM, Willett WC . Beyond low-fat diets New Engl J Med 1997 337: 563–566.

    CAS  PubMed  Google Scholar 

  4. Willett WC . Is dietary fat a major determinant of body fat? Am J Clin Nutr 1998 67 (Suppl): 556S–562S.

    Article  CAS  Google Scholar 

  5. Mensink RP, Katan MB . Effect of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials Arterioscler Thromb 1992 12: 911–919.

    Article  CAS  Google Scholar 

  6. Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton P . Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis Am J Clin Nutr 1999 69: 632–646.

    Article  CAS  Google Scholar 

  7. Skov A, Toubro S, Raben A, Astrup A . A method to achieve control of dietary macronutrient composition in ad libitum diets consumed by free-living subjects Eur J Clin Nutr 1997 51: 667–672.

    Article  CAS  Google Scholar 

  8. FAO/WHO/UNU . Energy and protein requirements WHO Technical Report Series 724. WHO: Geneva 1985.

  9. Baecke JAH, Burema J, Frÿtters JER . A short questionnaire for the measurement of habitual physical activity in epidemiological studies Am J Clin Nutr 1982 36: 932–942.

    Article  Google Scholar 

  10. Lukaski HC, Bolonchuk WW, Hall CB, Siders WA . Validation of tetrapolar bioelectrical impedance method to assess human body composition J Appl Physiol 1986 60: 1327–1332.

    Article  CAS  Google Scholar 

  11. Temme EHM, Mensink RP, Hornstra G . Effects of medium chain fatty acids (MCFA), myristic acid and oleic acid on serum lipoproteins in healthy subjects J Lip Res 1997 38: 1746–1754.

    CAS  Google Scholar 

  12. Friedewald WT, Levy RI, Frederickson DS . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of preparative ultracentrifuge Clin Chem 1972 18: 499–502.

    CAS  Google Scholar 

  13. Pasman WJ, Westerterp-Plantenga MS, Saris WHM . The effect of exercise training on leptin levels in obese males Am J Phys (Endocrinol Metab) 1998 274: E280–E286.

    Article  CAS  Google Scholar 

  14. Seidell JC . Dietary fat and obesity: an epidemiological perspective Am J Clin Nutr 1998 67 (Suppl): 546S–550S.

    Article  CAS  Google Scholar 

  15. Bray GA, Popkin BM . Dietary fat intake does affect obesity! Am J Clin Nutr 1998 68: 1157–1173.

    Article  CAS  Google Scholar 

  16. Schoeller DA . How accurate is self reported dietary intake? Nutr Rev 1990 48: 373–379.

    Article  CAS  Google Scholar 

  17. Hill JO, Prentice AM . Sugar and body weight regulation Am J Clin Nutr 1995 62 (Suppl): 264S–274S.

    Article  CAS  Google Scholar 

  18. Bolton-Smith C, Woodward M . Dietary composition and fat sugar ratios in relation to obesity Int J Obes Relat Metab Disord 1994 18: 820–828.

    CAS  PubMed  Google Scholar 

  19. Blaak EE, Saris WHM . Health aspects of various digestible carbohydrates Nutr Rev 1995 15: 1547–1573.

    CAS  Google Scholar 

  20. Stubbs RJ, Ritz P, Coward WA, Prentice AM . Covert manipulation of the dietary fat to carbohydrate ratio and energy density: effect on food intake and energy balance in free-living men, feeding ad libitum Am J Clin Nutr 1995 62: 330–337.

    Article  CAS  Google Scholar 

  21. Rose G . Population distributions of risk and disease Nutr Metab Card Vasc Dis 1991 1: 37–40.

    Google Scholar 

  22. Hill JO, Peters JC . Environmental contributions to the obesity epidemic Science 1998 280: 1371–1374.

    Article  CAS  Google Scholar 

  23. Mustad V, Derr J, Reddy CC, Pearson TA, Kris-Etherton PM . Seasonal variation in parameters related to coronary heart disease risk in young men Atherosclerosis 1996 126: 117–129.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We commemorate the important input of the late Professor Foppe ten Hoor, MD, PhD, in managing the CARMEN project in its initial phase. We are indebted to the trial participants for their sustained commitment to CARMEN and to Désirée EM Morales Belmar-Slippens for her secretarial coordinating support. Funding: supported by a grant from the EU-FAIR program PL95-0809 and by grants from European Sugar industries. The following companies donated food: Campina Melkunie, Coca Cola,De Ruyter, Dolmio, General Biscuit, Daloon, Danisco, Danish Prime Food, Danone, Delimo, Flensted, Hak, Hansa, Haribo, Hatting Bageri, Havnemollerne, Heinz, Honig, Jonker Fris, Kellogg's, Kelsen, Malaco, Mars, Master Foods, Mayo, Minute Maid, Nestle, Pingvin Lakrids, Red Band Venco, Rynkeby Foods, Schulstad Brod, Unilever, Vestjyske Slagterier and Zentis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to WHM Saris.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saris, W., Astrup, A., Prentice, A. et al. Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. Int J Obes 24, 1310–1318 (2000). https://doi.org/10.1038/sj.ijo.0801451

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801451

Keywords

This article is cited by

Search

Quick links