The research article by Gardner et al. (2018) was focused on the major healthcare related problems of 21st century, Obesity. People are focused on using two specific strategies for their weight loss such as low fat diet and low carbohydrate diet. The aim of the study was to determine the effect of these type of diets as well the effect of dynamics of insulin-glucose or genotypes in deciding the effect of the diets (Gardner et al., 2018). For this purpose, the research article conducted randomized control trial among 609 overweight patients for 12 months. Therefore, the two primary hypotheses was significant diet in combination with genotype for effective weight loss, whereas the other hypothesis was specific diet and the effect of insulin for effective weight loss (Gardner et al., 2018).
For this research, the participants were collected from newspaper articles, emails, media coverage and from that population, 609 men and premenopausal women were selected for this purpose. The age limit of the population was kept from 18 to 50 years with body mass index ranging from 28 to 40 (Gardner et al., 2018). All these people were divided into three groups randomly and then provided with low-fat and low-carbohydrate food with specific genotype or insulin-glucose reaction for 12 months of period. The procedure of the study was double factorial matching with diet with genotype-pattern matching. Therefore as per this design, one group comprises of 305 participant and received HLF (Low fat) diet, where as the other group comprised of 304 men provided with HLC (Low carbohydrate) diet (Gardner et al., 2018).
The participants underwent 22 diet related interventions and the mean number of low fat and low carbohydrate related sessions was 14.4 and 14.6 respectively. As well as the two groups were provided with different carbohydrates, fat, protein, saturated fat intake chart. After the intervention, the primary outcome was difference of average -5.5kg for the healthy low fat diet group whereas; the difference in healthy low carbohydrate group was -6.0kg (Gardner et al., 2018). However, the changes of weight increase when the groups were interchanged from low-fat diet and low-fat genotype to a low carbohydrate and low carbohydrate genotype. However, while discussing the secondary outcome, it should be mentioned that no such difference was observed in the body mass index, waist circumference and body fat percentage. Further, the findings also indicated that both the diets were able to improve the lipid related profile, lowered their blood pressure, lowered their blood glucose and insulin levels. However, the difference was found in low carbohydrate and low fat groups as the high density lipo protein cholesterol increased in low carbohydrate diet, where as the low fat diet was able to lower this high density lipo protein cholesterol. Moreover, the rate of respiratory exchange was also not found to be changed significantly and the resting energy expenditure also remained unchanged in both the groups (Gardner et al., 2018). Further, the groups also did not witness any significant changes with changing genotypes and insulin and glucose combinations. However, the energy expenditure increases in both the group and determine significant changes from the baseline witnessed prior to the study. Both the three way interaction of diet, genotype and the 12 month diet program was not being able to provide positive results in favor of the research hypotheses and in both the groups prior and after mismatched, the average weight loss was found to be 5% or nearby. However, the sample size was big, retention of the diet, and interventions were strong substantial weight loss was not visible in both the groups. Therefore, both the hypotheses were proven to be wrong for this study as both the low fat and low carbohydrate diets with combination of genotypes and insulin-glucose combination was not being able to prove the hypothesis of the research article (Gardner et al., 2018).
As the research hypothesis was not met, several internal and external potential threats can be identified from the study. The internal risk factors were associated with the adverse events that occurred while conducting the study. While conducting the study, due to the intervention or study design, total 7 participants seriously ill were admitted to the hospital within which 2 admissions were due to the study design. Further, total 11 participants were affected due to adverse events within which nine of them suffering due to study design. Therefore, this contributed towards the internal risk factors of the conducted study to determine the effective diet for weight loss among low fat and low carbohydrate diets. Further, the external risk factor was inclusion of participants from a specific geographical location who were able to consume food of their choice as they had such resources (Santos et al., 2012). Further, the external risk factor also includes the unavailability of broad study related to genetic characteristic related effect of insulin, therefore limited the findings of the research article and also altered the health of several participants creating adverse events for them. Besides these, the study did not included the three main anthropometric variables namely the body fat index, the resti8ng energy expenditure and the respiratory exchange ratio (Paoli et al., 2013). These missing factors allowed the statistical gaps in the study outcomes and therefore it becomes one of the external risk factors for the study population and study design. Finally, the receptor, which was chosen to identify the insulin secretion, INS-30, was only a proxy measure of insulin secretion therefore the study measurement and calculations were affected due to this absence of actual insulin secretion markers affecting the study results and hypothesis. It can be said as Hu et al. (2012) has also determined the effect of diet difference with insulin secretion on the weight loss in their research study (Bazzano et al., 2014).
Therefore, while concluding this study assignment of research article by Gardner et al. (2018), several recommendations should be suggested so that these potential treats can be overcome and the research hypothesis can be testified. The selection of participants can be done only one the basis of their racial and ethnic diversity further their education level should also be limited so that they canbno0t understand the purpose of the study and do not consume any food as per their choice to affect the study results (Bueno et al., 2013). As well as the insulin, concentration should also be modified and other important receptors should be marked for insulin secretion identification (Friedman et al., 2012). The participants should be provided with physical activities so that health related adverse effects could not be witnessed. As the study design was randomized control trail, the research was unable to include the result of analysis of interactions (Hussain et al., 2012). Therefore, such interactions should be included in the study design so that holistic results can be generated. Besides these, insulin dynamics as well as the genetic uniqueness should also be assessed in the research article (Guldbrand et al., 2012).
References
Bazzano, L. A., Hu, T., Reynolds, K., Yao, L., Bunol, C., Liu, Y., … & He, J. (2014). Effects of low-carbohydrate and low-fat diets: a randomized trial. Annals of internal medicine, 161(5), 309-318. DOI: 10.7326/M14-0180
Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187. DOI: https://doi.org/10.1017/S0007114513000548
Friedman, A. N., Ogden, L. G., Foster, G. D., Klein, S., Stein, R., Miller, B., … & Wyatt, H. R. (2012). Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clinical journal of the American Society of Nephrology, 7(7), 1103-1111 doi: 10.2215/?CJN.11741111
Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. P., … & King, A. C. (2018). Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial. Jama, 319(7), 667-679. doi:10.1001/jama.2018.0245
Guldbrand, H., Dizdar, B., Bunjaku, B., Lindström, T., Bachrach-Lindström, M., Fredrikson, M., … & Nystrom, F. H. (2012). In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia, 55(8), 2118-2127. DOI: https://doi.org/10.1007/s00125-012-2567-4
Hu, T., Mills, K. T., Yao, L., Demanelis, K., Eloustaz, M., Yancy Jr, W. S., … & Bazzano, L. A. (2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. American journal of epidemiology, 176(suppl_7), S44-S54. DOI: https://doi.org/10.1093/aje/kws264
Hussain, T. A., Mathew, T. C., Dashti, A. A., Asfar, S., Al-Zaid, N., & Dashti, H. M. (2012). Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 28(10), 1016-1021. DOI: https://doi.org/10.1016/j.nut.2012.01.016
Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 67(8), 789. DOI: https://doi.org/10.1038/ejcn.2013.116
Santos, F. L., Esteves, S. S., da Costa Pereira, A., Yancy Jr, W. S., & Nunes, J. P. L. (2012). Systematic review and meta?analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity reviews, 13(11), 1048-1066. DOI: https://doi.org/10.1111/j.1467-789X.2012.01021.x
Wycherley, T. P., Moran, L. J., Clifton, P. M., Noakes, M., & Brinkworth, G. D. (2012). Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials–. The American journal of clinical nutrition, 96(6), 1281-1298. . DOI: https://doi.org/10.3945/ajcn.112.044321
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