Diets differing in carbohydrate cellularity and amount similarly reduced visceral fat in people with obesity - a randomized controlled trial (CARBFUNC)
Cathrine Horn Sommersten, Johnny Laupsa‐Borge, Amanda IO. Andersen, Kristine E. Fasmer, Mari-Anna Holmefjord, Ingrid Revheim, Kristine Kjerpeseth Johannessen, Nicole Tandrevold Næsheim, Inghild Storås, Trine Leikanger, Kristin Amundsen, Karoline Lyngstad Skjerve, Laurence Lawrence‐Archer, Camilla Spjelkavik, Ingfrid S. Haldorsen, Inge Lindseth, Jutta Dierkes, Gunnar Mellgren, Simon N. Dankel
Abstract
BACKGROUND & AIMS: Visceral adipose tissue (VAT) volume is associated with common lifestyle diseases. Dietary quality, including food matrix and degree of carbohydrate cellularity, as well as the carbohydrate/fat ratio, may influence VAT volume. We aimed to determine the effects of isocaloric diets differing in either "cellularity", a novel marker of dietary carbohydrate quality, or carbohydrate amount on visceral fat volume and anthropometric measures in adults with obesity. METHODS: In a randomized controlled trial of 193 people with obesity/central adiposity, we compared changes in VAT volume after 6 and 12 months, measured by abdominal computed tomography, on three isocaloric eating patterns based on "acellular" carbohydrate sources (e.g., flour-based whole-grain products; comparator arm), "cellular" carbohydrate sources (minimally processed foods with intact cellular structures such as fruits, potatoes/tubers, and rice), or low-carbohydrate high-fat (LCHF) principles. Outcomes were compared by an intention-to-treat (ITT) analysis using constrained linear mixed-effects modelling (cLMM) providing baseline-adjusted change scores and proper missing data handling without imputation. RESULTS: 78 and 57 participants completed 6 and 12 months, respectively, with similar intakes of energy (females: 1820-2060 kcal, males: 2480-2550 kcal) and protein (16-17 energy percent, E%) throughout the intervention, and only modest reductions in energy from baseline. Reported dietary intakes were 42-44, 41-42, and 11-15 E% carbohydrate and 36-38, 37-38, and 66-70 E% fat in the acellular, cellular and LCHF groups, respectively. There were no significant between-group differences in VAT volume after 6 months (cellular vs. acellular [95% CI]: -55 cm³ [-545, 436]; LCHF vs. acellular [95% CI]: -225 cm³ [-703, 253]) or after 12 months (cellular vs. acellular [95% CI]: -122 cm³ [-757, 514]; LCHF vs. acellular [95% CI]: -317 cm³ [-943, 309]). VAT volume decreased significantly within all groups by 14-18% and 12-17% after 6 and 12 months, respectively. Waist circumference was reduced to a significantly greater degree in the LCHF vs. acellular group at 6 months (LCHF vs. acellular [95% CI]: -2.78 cm [-5.54, -0.017]). CONCLUSIONS: Despite modest energy restriction, the three isocaloric eating patterns, differing in carbohydrate cellularity and amount, decreased visceral fat volume significantly and to a similar clinically relevant degree. CLINICAL TRIALS IDENTIFIER: NCT03401970. https://clinicaltrials.gov/ct2/show/NCT03401970.