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To the Editor: The study by Dr Pereira and colleagues¹ showed a smaller reduction in resting energy expenditure during a low–glycemic load diet compared with a low-fat diet in a group of patients who were obese. Although the results of the study seem to favor the use of the low–glycemic load diet, the selection criteria may have introduced a selection bias so that the patients were representative of no more than 20% of the obese population. We base this on the following 3 considerations. First, the prevalence of the metabolic syndrome may be up to 70% in obese women.^2-3 In this study, 3 of 4 patients were women, yet metabolic syndrome was not present. Second, although a minority of people who are obese may be free of insulin resistance, it appears that this study population did not have insulin resistance. Third, the absence of the metabolic syndrome and the normality . . . [Full Text of this Article]

Katherine Esposito, MD
katherine.esposito@unina2.it

Dario Giugliano, MD, PhD
Department of Geriatrics and Metabolic Diseases
Second University of Naples
Naples, Italy

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