Journal Club
Bazzano LA, Hu T, Reynolds K, Yao L, Bunol C, Liu Y, Chen CS, Klag MJ,
Whelton PK, He J.
Effects of low-carbohydrate and low-fat diets: a randomized trial.
Ann Intern Med. 2014 Sep 2;161(5):309-18. doi: 10.7326/M14-0180.
Johnston BC1, Kanters S2, Bandayrel K3, Wu P4, Naji F5, Siemieniuk RA6,
Ball GD7, Busse JW8, Thorlund K9, Guyatt G10, Jansen JP11, Mills EJ12.
Comparison of weight loss among named diet programs in overweight and
obese adults: a meta-analysis.
JAMA. 2014 Sep 3;312(9):923-33. doi: 10.1001/jama.2014.10397.
2014年9月18日 8:30-8:55
８階 医局
埼玉医科大学 総合医療センター 内分泌・糖尿病内科
Department of Endocrinology and Diabetes,
Saitama Medical Center, Saitama Medical University
松田 昌文
Matsuda, Masafumi
血糖値の調節
血糖値は制御され
た値であり制御機
構が正常なら全く
血糖は上昇しな
い！
膵臓
脂肪組織
インスリン
↑
尿糖
血糖
200 g/日
Plasma Glucose
Blood Glucose
グリコーゲン
肝臓
120g/日
乳
酸
グリコーゲン
筋肉
脳
(食事)
40g/日 その他のブドウ糖
のみ用いる組織
ブドウ糖とは？
ヒトの脳の唯一のエネルギー源
MANN, F. C., and MAGATH, T. B. (1922).-Arch. Intern. Moo. 30: 171.
検査値としての血糖は
plasma glucose: PG
(mg of glucose per dl
of plasma)で表記され
ます。
脳の１日ブドウ糖使用量
ブドウ糖120ｇ ＝ 糖質108ｇ
Original Article
Weight Loss with a Low-Carbohydrate,
Mediterranean, or Low-Fat Diet
Israel, Germany, Boston
Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula
Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady
Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., Benjamin Sarusi,
M.Sc., Dov Brickner, M.D., Ziva Schwartz, M.D., Einat Sheiner, M.D., Rachel Marko, M.Sc., Esther Katorza,
M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D., Michael Stumvoll, M.D., Meir
J. Stampfer, M.D., Dr.P.H., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group
In this 2-year trial, we randomly
assigned 322 moderately obese
subjects (mean age, 52 years;
mean body-mass index [the
weight in kilograms divided by the
square of the height in meters],
31; male sex, 86%) to one of three
diets: low-fat, restricted-calorie;
Mediterranean, restricted-calorie;
or low-carbohydrate, non–
restricted-calorie.
Shai I et al. N Engl J Med 2008;359:229-241
Weight Changes during 2 Years According to Diet Group
Shai I et al. N Engl J Med 2008;359:229-241
Difference in Mean Weight Loss Across Diets
With 95%Credible Intervals
The values above the named diets (blue boxes) correspond to the difference in mean weight lost between
the columns and row at 12 months (eg, the difference in average weight lost between the Ornish diet and
no diet at 12 months is 6.55 kg). The values below the diet classes correspond to the difference in mean
weight lost between the row and the column at 6 months (eg, the difference in average weight lost
between the Ornish diet and no diet at 6 months is 9.03 kg). LEARN indicates Lifestyle, Exercise,
Attitudes, Relationships, and Nutrition.
JAMA. 2014;312(9):923-933
「糖尿病における食事療法の在り方と課題」 提言
1） 糖尿病における炭水化物*摂取について
総エネルギー摂取量を制限せずに、炭水化物のみを
100g/日(ブドウ糖～120g相当)以下に制限することによって減量を
図ることは、その本来の効果のみならず、長期的な食事
療法としての遵守性や安全性など重要な点についてこれ
を担保するエビデンスが不足しており、現時点では薦めら
れない。
2） 栄養素摂取比率について
糖尿病における三大栄養素の推奨摂取比率は、一般的
には、炭水化物50~60%(150g以上)、タンパク質20%以
下のこりを脂質(上限25%)とする。 １日1000kcal以上
*:エネルギー源としての炭水化物：ブドウ糖として直接腸管から吸収される食物
Tulane University School of Public Health and Tropical Medicine, New Orleans,
Louisiana; Kaiser Permanente Southern California, Pasadena, California; and
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Ann Intern Med. 2014;161(5):309-318. doi:10.7326/M14-0180
Background: Low-carbohydrate diets
are popular for weight loss, but their
cardiovascular effects have not been
well-studied, particularly in diverse
populations.
Objective: To examine the effects of a
low-carbohydrate diet compared with a
low-fat diet on body weight and
cardiovascular risk factors.
Design: A randomized, parallel-group trial.
(ClinicalTrials.gov: NCT00609271)
Setting: A large academic medical center.
Participants: 148 men and women without
clinical cardiovascular disease and diabetes.
Intervention: A low-carbohydrate (<40 g/d) or
low-fat (<30% of daily energy intake from total fat
[<7% saturated fat]) diet. Both groups received
dietary counseling at regular intervals throughout
the trial.
Measurements: Data on weight, cardiovascular
risk factors, and dietary composition were
collected at 0, 3, 6, and 12 months.
Figure 1. Study flow diagram.
* 5 participants in the low-fat group and
6 in the low-carbohydrate group had no
data on body weight at randomization.
Results: Sixty participants (82%) in the low-fat group
and 59 (79%) in the low-carbohydrate group completed
the intervention. At 12 months, participants on the lowcarbohydrate diet had greater decreases in weight
(mean difference in change, −3.5 kg [95% CI, −5.6 to
−1.4 kg]; P = 0.002), fat mass (mean difference in
change, −1.5% [CI, −2.6% to −0.4%]; P = 0.011), ratio of
total–high-density lipoprotein (HDL) cholesterol (mean
difference in change, −0.44 [CI, −0.71 to −0.16]; P =
0.002), and triglyceride level (mean difference in
change, −0.16 mmol/L [−14.1 mg/dL] [CI, −0.31 to −0.01
mmol/L {−27.4 to −0.8 mg/dL}]; P = 0.038) and greater
increases in HDL cholesterol level (mean difference in
change, 0.18 mmol/L [7.0 mg/dL] [CI, 0.08 to 0.28
mmol/L {3.0 to 11.0 mg/dL}]; P < 0.001) than those on
the low-fat diet.
Limitation: Lack of clinical cardiovascular
disease end points.
Conclusion: The low-carbohydrate diet
was more effective for weight loss and
cardiovascular risk factor reduction than the
low-fat diet. Restricting carbohydrate may
be an option for persons seeking to lose
weight and reduce cardiovascular risk
factors.
Primary Funding Source: National
Institutes of Health.
Message
心血管疾患および糖尿病既往のない男女119人を
対象に、低炭水化物食と低脂肪食の減量および
心血管リスク軽減効果を無作為化試験で比較。
低炭水化物食群で低脂肪食群に比べ、12カ月時
の体重、体脂肪、総コレステロールと高比重リ
ポタンパク（HDL）コレステロールの比率、トリ
グリセリド値が低下し、HDLコレステロール値は
増加した。
心血管障害について調べると言っておいて、実
際のデータがないのは．．．(liminationには言
及してはいるが)
1Hospital
for Sick Children Research Institute, Toronto, Ontario, Canada
of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
4Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
5School of Population and Public Health, University of British Columbia, Vancouver, Canada
6Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
7Redwood Outcomes, Vancouver, British Columbia, Canada
8Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
9Department of Medicine, University of Toronto, Toronto, Ontario, Canada
10Department of Pediatrics, University of Alberta, Edmonton, Canada
11Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
12Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
13Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
14Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California
15Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts
2Institute
JAMA. 2014;312(9):923-933. doi:10.1001/jama.2014.10397.
Importance Many claims have
been made regarding the
superiority of one diet or another for
inducing weight loss. Which diet is
best remains unclear.
Objective To determine weight
loss outcomes for popular diets
based on diet class (macronutrient
composition) and named diet.
Data Sources Search of 6 electronic databases: AMED, CDSR,
CENTRAL, CINAHL, EMBASE, and MEDLINE from inception of
each database to April 2014.
Study Selection Overweight or obese adults (body mass index
≥25) randomized to a popular self-administered named diet and
reporting weight or body mass index data at 3-month follow-up or
longer.
Data Extraction and Synthesis Two reviewers independently
extracted data on populations, interventions, outcomes, risk of
bias, and quality of evidence. A Bayesian framework was used to
perform a series of random-effects network meta-analyses with
meta-regression to estimate the relative effectiveness of diet
classes and programs for change in weight and body mass index
from baseline. Our analyses adjusted for behavioral support and
exercise.
Main Outcomes and Measures Weight loss and body mass
index at 6- and 12-month follow-up (±3 months for both periods).
Results Among 59 eligible articles reporting 48 unique
randomized trials (including 7286 individuals) and compared
with no diet, the largest weight loss was associated with lowcarbohydrate diets (8.73 kg [95% credible interval {CI}, 7.27
to 10.20 kg] at 6-month follow-up and 7.25 kg [95% CI, 5.33
to 9.25 kg] at 12-month follow-up) and low-fat diets (7.99 kg
[95% CI, 6.01 to 9.92 kg] at 6-month follow-up and 7.27 kg
[95% CI, 5.26 to 9.34 kg] at 12-month follow-up). Weight loss
differences between individual diets were minimal. For
example, the Atkins diet resulted in a 1.71 kg greater weight
loss than the Zone diet at 6-month follow-up. Between 6- and
12-month follow-up, the influence of behavioral support (3.23
kg [95% CI, 2.23 to 4.23 kg] at 6-month follow-up vs 1.08 kg
[95% CI, −1.82 to 3.96 kg] at 12-month follow-up) and
exercise (0.64 kg [95% CI, −0.35 to 1.66 kg] vs 2.13 kg [95%
CI, 0.43 to 3.85 kg], respectively) on weight loss differed.
Conclusions and Relevance
Significant weight loss was observed
with any low-carbohydrate or low-fat
diet. Weight loss differences between
individual named diets were small. This
supports the practice of recommending
any diet that a patient will adhere to in
order to lose weight.
Message
代表的なダイエット法と食事介入なしを比べた
無作為化試験48件（肥満/過体重患者7286人）を
対象に、ダイエット法の減量効果をメタ解析で
比較。低炭水化物食および低脂肪食は最も大幅
な体重減少と関連していたが、各種ダイエット
間での減量差は小さかった。この結果から、患
者が順守できるダイエット法を推奨するのが良
いことが示唆された。
カロリー制限が重要そうだが。