This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Abhimanyu Garg, MBBS, MD; John P. Bantle, MD; Robert R. Henry, MD; Ann M. Coulston, RD; Kay A. Griver, RD; Susan K. Raatz, MS, RD; Linda Brinkley, RD; Y-D. Ida Chen, PhD; Scott M. Grundy, MD, PhD; Beverley A. Huet, MS; Gerald M. Reaven, MD

JAMA. 1994;271(18):1421-1428.

Abstract
Objective.
—To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non—insulin-dependent diabetes mellitus (NIDDM).

Design.
—A four-center randomized crossover trial.

Setting.
—Outpatient and inpatient evaluation in metabolic units.

Patients.
—Forty-two NIDDM patients receiving glipizide therapy.

Interventions.
—A high-carbohydrate diet containing 55% of the total energy as carbohydrates and 30% as fats was compared with a high—monounsaturated-fat diet containing 40% carbohydrates and 45% fats. The amounts of saturated fats, polyunsaturated fats, cholesterol, sucrose, and protein were similar. The study diets, prepared in metabolic kitchens, were provided as the sole nutrients to subjects for 6 weeks each. To assess longer-term effects, a subgroup of 21 patients continued the diet they received second for an additional 8 weeks.

Main Outcome Measures.
—Fasting plasma glucose, insulin, lipoproteins, and glycosylated hemoglobin concentrations. Twenty-four-hour profiles of glucose, insulin, and triglyceride levels.

Results.
—The site of study as well as the diet order did not affect the results. Compared with the high—monounsaturated-fat diet, the high-carbohydrate diet increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24% (P<.0001) and 23% (P=.0001), respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10% (P=.03), 12% (P<.0001), and 9% (P=.02), respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects of both diets on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks.

Conclusions.
—In NIDDM patients, high-carbohydrate diets compared with high—monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia, as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels, which may not be desirable.

(JAMA. 1994;271:1421-1428)

Author Affiliations
From the Center for Human Nutrition and Department of Internal Medicine (Drs Garg and Grundy) and the General Clinical Research Center (Dr Garg and Mss Brinkley and Huet), University of Texas Southwestern Medical Center at Dallas; Department of Internal Medicine, Stanford (Calif) University School of Medicine (Drs Chen and Reaven and Ms Coulston); Department of Medicine, University of Minnesota, Minneapolis (Dr Bantle and Ms Raatz); Department of Medicine, University of California—San Diego (Dr Henry); and the Veterans Affairs Medical Center, San Diego, Calif (Dr Henry and Ms Griver).

Footnotes
Reprint requests to University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235-9052 (Dr Garg).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
Kodama et al.
Diabetes Care 2009;32:959-965.
ABSTRACT | FULL TEXT  

Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial
Delahanty et al.
Am. J. Clin. Nutr. 2009;89:518-524.
ABSTRACT | FULL TEXT  

Effect of 2 Liquid Nutritional Supplements for Diabetes Patients on Postprandial Glucose, Insulin Secretion, and Insulin Sensitivity in Healthy Individuals
Gonzalez-Ortiz et al.
JPEN J Parenter Enteral Nutr 2009;33:67-70.
ABSTRACT | FULL TEXT  

Comparison of the effects on insulin resistance and glucose tolerance of 6-mo high-monounsaturated-fat, low-fat, and control diets
Due et al.
Am. J. Clin. Nutr. 2008;87:855-862.
ABSTRACT | FULL TEXT  

The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein
Wolever et al.
Am. J. Clin. Nutr. 2008;87:114-125.
ABSTRACT | FULL TEXT  

Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association
American Diabetes Association
Diabetes Care 2008;31:S61-S78.
FULL TEXT  

Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states
Berglund et al.
Am. J. Clin. Nutr. 2007;86:1611-1620.
ABSTRACT | FULL TEXT  

Lipid, Glycemic, and Insulin Responses to Meals Rich in Saturated, cis-Monounsaturated, and Polyunsaturated (n-3 and n-6) Fatty Acids in Subjects With Type 2 Diabetes
Shah et al.
Diabetes Care 2007;30:2993-2998.
ABSTRACT | FULL TEXT  

Supplementation of Conventional Therapy With the Novel Grain Salba (Salvia hispanica L.) Improves Major and Emerging Cardiovascular Risk Factors in Type 2 Diabetes: Results of a randomized controlled trial
Vuksan et al.
Diabetes Care 2007;30:2804-2810.
ABSTRACT | FULL TEXT  

Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome
Muzio et al.
Am. J. Clin. Nutr. 2007;86:946-951.
ABSTRACT | FULL TEXT  

Themed Review: Lifestyle Interventions Across the Continuum of Type 2 Diabetes: Reducing the Risks of Diabetes
Franz
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:327-334.
ABSTRACT  

Serum Alanine Aminotransferase Levels Decrease Further With Carbohydrate Than Fat Restriction in Insulin-Resistant Adults
Ryan et al.
Diabetes Care 2007;30:1075-1080.
ABSTRACT | FULL TEXT  

Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults
Maki et al.
Am. J. Clin. Nutr. 2007;85:724-734.
ABSTRACT | FULL TEXT  

Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association
American Diabetes Association
Diabetes Care 2007;30:S48-S65.
FULL TEXT  

Nutrition Recommendations and Interventions for Diabetes-2006: A position statement of the American Diabetes Association.
American Diabetes Association
Diabetes Care 2006;29:2140-2157.
FULL TEXT  

Thematic review series: Patient-Oriented Research. Nutritional determinants of insulin resistance
McAuley and Mann
J. Lipid Res. 2006;47:1668-1676.
ABSTRACT | FULL TEXT  

Effect of a High-Carbohydrate Versus a High--cis-Monounsaturated Fat Diet on Blood Pressure in Patients With Type 2 Diabetes
Shah et al.
Diabetes Care 2005;28:2607-2612.
ABSTRACT | FULL TEXT  

Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement
Grundy et al.
Circulation 2005;112:2735-2752.
FULL TEXT  

Weight Management Using Lifestyle Modification in the Prevention and Management of Type 2 Diabetes: Rationale and Strategies
The American Diabetes Association et al.
Clin. Diabetes 2005;23:130-136.
FULL TEXT  

Dietary carbohydrates and glycaemic load and the incidence of symptomatic gall stone disease in men
Tsai et al.
Gut 2005;54:823-828.
ABSTRACT | FULL TEXT  

Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids
Luscombe-Marsh et al.
Am. J. Clin. Nutr. 2005;81:762-772.
ABSTRACT | FULL TEXT  

Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes
Boden et al.
ANN INTERN MED 2005;142:403-411.
ABSTRACT | FULL TEXT  

More support for dietary patterns involving high-fiber, high-complex carbohydrates
McCarthy
Am. J. Clin. Nutr. 2005;81:724-724.
FULL TEXT  

Exercise Is Required for Visceral Fat Loss in Postmenopausal Women with Type 2 Diabetes
Giannopoulou et al.
J. Clin. Endocrinol. Metab. 2005;90:1511-1518.
ABSTRACT | FULL TEXT  

Glycemic and Lipid Control in Hospitalized Type 2 Diabetic Patients: Evaluation of 2 Enteral Nutrition Formulas (Low Carbohydrate-High Monounsaturated Fat vs High Carbohydrate)
Leon-Sanz et al.
JPEN J Parenter Enteral Nutr 2005;29:21-29.
ABSTRACT | FULL TEXT  

Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes
Gerhard et al.
Am. J. Clin. Nutr. 2004;80:668-673.
ABSTRACT | FULL TEXT  

Impact of the Bienestar School-Based Diabetes Mellitus Prevention Program on Fasting Capillary Glucose Levels: A Randomized Controlled Trial
Trevino et al.
Arch Pediatr Adolesc Med 2004;158:911-917.
ABSTRACT | FULL TEXT  

Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes
Gannon and Nuttall
Diabetes 2004;53:2375-2382.
ABSTRACT | FULL TEXT  

Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Klein et al.
Am. J. Clin. Nutr. 2004;80:257-263.
ABSTRACT | FULL TEXT  

Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies: A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Klein et al.
Diabetes Care 2004;27:2067-2073.
FULL TEXT  

Glycemic Index, Glycemic Load, and Carbohydrate Intake in Relation to Risk of Distal Colorectal Adenoma in Women
Oh et al.
Cancer Epidemiol. Biomarkers Prev. 2004;13:1192-1198.
ABSTRACT | FULL TEXT  

Cardiovascular disease risk in women with diabetes needs attention
Coulston
Am. J. Clin. Nutr. 2004;79:931-932.
FULL TEXT  

Effect of macronutrient intake on the development of glucose intolerance during pregnancy
Saldana et al.
Am. J. Clin. Nutr. 2004;79:479-486.
ABSTRACT | FULL TEXT  

Type 2 diabetes and the vegetarian diet
Jenkins et al.
Am. J. Clin. Nutr. 2003;78:610S-616.
ABSTRACT | FULL TEXT  

Carbohydrate intake and biomarkers of glycemic control among US adults: the third National Health and Nutrition Examination Survey (NHANES III)
Yang et al.
Am. J. Clin. Nutr. 2003;77:1426-1433.
ABSTRACT | FULL TEXT  

Long-term effect of varying the source or amount of dietary carbohydrate on postprandial plasma glucose, insulin, triacylglycerol, and free fatty acid concentrations in subjects with impaired glucose tolerance
Wolever and Mehling
Am. J. Clin. Nutr. 2003;77:612-621.
ABSTRACT | FULL TEXT  

Carbohydrate Intake Is Associated with Diet Quality and Risk Factors for Cardiovascular Disease in U.S. Adults: NHANES III
Yang et al.
J. Am. Coll. Nutr. 2003;22:71-79.
ABSTRACT | FULL TEXT  

So Many Nutrition Recommendations--Contradictory or Compatible?
Franz
Diabetes Spectr. 2003;16:56-63.
FULL TEXT  

Lipodystrophy in Human Immunodeficiency Virus-Infected Patients
Chen et al.
J. Clin. Endocrinol. Metab. 2002;87:4845-4856.
ABSTRACT | FULL TEXT  

The Plasma and Lipoprotein Triglyceride Postprandial Response to a Carbohydrate Tolerance Test Differs in Lean and Massively Obese Normolipidemic Women
Dallongeville et al.
J. Nutr. 2002;132:2161-2166.
ABSTRACT | FULL TEXT  

Glycemic index: overview of implications in health and disease
Jenkins et al.
Am. J. Clin. Nutr. 2002;76:266S-273.
ABSTRACT | FULL TEXT  

Do colonic short-chain fatty acids contribute to the long-term adaptation of blood lipids in subjects with type 2 diabetes consuming a high-fiber diet?
Wolever et al.
Am. J. Clin. Nutr. 2002;75:1023-1030.
ABSTRACT | FULL TEXT  

Effects of Energy-Restricted Diets Containing Increased Protein on Weight Loss, Resting Energy Expenditure, and the Thermic Effect of Feeding in Type 2 Diabetes
Luscombe et al.
Diabetes Care 2002;25:652-657.
ABSTRACT | FULL TEXT  

Carbohydrates and Colorectal Cancer Risk among Chinese in North America
Borugian et al.
Cancer Epidemiol. Biomarkers Prev. 2002;11:187-193.
ABSTRACT | FULL TEXT  

Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications
Franz et al.
Diabetes Care 2002;25:148-198.
FULL TEXT  

Dietary Fat and Incidence of Type 2 Diabetes in Older Iowa Women
Meyer et al.
Diabetes Care 2001;24:1528-1535.
ABSTRACT | FULL TEXT  

High-protein diets in hyperlipidemia: effect of wheat gluten on serum lipids, uric acid, and renal function
Jenkins et al.
Am. J. Clin. Nutr. 2001;74:57-63.
ABSTRACT | FULL TEXT  

Monounsaturated Fatty Acid Diets Improve Glycemic Tolerance through Increased Secretion of Glucagon-Like Peptide-1
Rocca et al.
Endocrinology 2001;142:1148-1155.
ABSTRACT | FULL TEXT  

Glycemic load and the risk of coronary heart disease
Katz
Am. J. Clin. Nutr. 2001;73:131-132.
FULL TEXT  

Diet-induced change in fatty acid composition of plasma triacylglycerols is not associated with change in glucagon-like peptide 1 or insulin sensitivity in people with type 2 diabetes
Brynes et al.
Am. J. Clin. Nutr. 2000;72:1111-1118.
ABSTRACT | FULL TEXT  

Comparison of high- and low-glycemic-index breakfast cereals with monounsaturated fat in the long-term dietary management of type 2 diabetes
Tsihlias et al.
Am. J. Clin. Nutr. 2000;72:439-449.
ABSTRACT | FULL TEXT  

A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women
Liu et al.
Am. J. Clin. Nutr. 2000;71:1455-1461.
ABSTRACT | FULL TEXT  

Beneficial Effects of High Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus
Chandalia et al.
NEJM 2000;342:1392-1398.
ABSTRACT | FULL TEXT  

Carbohydrates, dietary fiber, and incident type 2 diabetes in older women
Meyer et al.
Am. J. Clin. Nutr. 2000;71:921-930.
ABSTRACT | FULL TEXT  

Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms1
Parks and Hellerstein
Am. J. Clin. Nutr. 2000;71:412-433.
ABSTRACT | FULL TEXT  

Fractional oxidation of chylomicron-derived oleate is greater than that of palmitate in healthy adults fed frequent small meals
Schmidt et al.
J. Lipid Res. 1999;40:2322-2332.
ABSTRACT | FULL TEXT  

AHA Science Advisory: Monounsaturated Fatty Acids and Risk of Cardiovascular Disease
Kris-Etherton
J. Nutr. 1999;129:2280-2284.
FULL TEXT  

Monounsaturated Fatty Acids and Risk of Cardiovascular Disease
Kris-Etherton
Circulation 1999;100:1253-1258.
FULL TEXT  

The role of dietary fats in plant-based diets
Coulston
Am. J. Clin. Nutr. 1999;70:512S-515.
ABSTRACT | FULL TEXT  

Effect of Wheat Bran on Serum Lipids: Influence of Particle Size and Wheat Protein
Jenkins et al.
J. Am. Coll. Nutr. 1999;18:159-165.
ABSTRACT | FULL TEXT  

Differences in the Metabolism of Postprandial Lipoproteins After a High-Monounsaturated-Fat Versus a High-Carbohydrate Diet in Patients With Type 1 Diabetes Mellitus
Georgopoulos et al.
Arterioscler. Thromb. Vasc. Bio. 1998;18:773-782.
ABSTRACT | FULL TEXT  

Nutritional Management of Cardiovascular Risk Factors: A Randomized Clinical Trial
McCarron et al.
Arch Intern Med 1997;157:169-177.
ABSTRACT  

Ultrasonographically Assessed Maximum Carotid Artery Wall Thickness in Mexico City Residents and Mexican Americans Living in San Antonio, Texas: Association With Diabetes and Cardiovascular Risk Factors
Wei et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:1388-1392.
ABSTRACT | FULL TEXT  

Monounsaturated Versus Polyunsaturated Dietary Fat and Serum Lipids : A Meta-analysis
Gardner and Kraemer
Arterioscler. Thromb. Vasc. Bio. 1995;15:1917-1927.
ABSTRACT | FULL TEXT  

Varying Carbohydrate Intake in NIDDM
Ratner and Smith-Ratner
JAMA 1994;272:1817-1817.
ABSTRACT  

Varying Carbohydrate Intake in NIDDM
Schenck
JAMA 1994;272:1817-1817.
ABSTRACT  

Varying Carbohydrate Intake in NIDDM
McCarthy and Inkeles
JAMA 1994;272:1817-1818.
ABSTRACT