Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations - PubMed (original) (raw)

Comparative Study

Russell J de Souza et al. Am J Clin Nutr. 2008 Jul.

Abstract

Background: Enhancements to current dietary advice to prevent chronic disease are of great clinical and public health importance. The OmniHeart Trial compared 3 diets designed to reduce cardiovascular disease (CVD) risk-one high in carbohydrate and 2 that replaced carbohydrate with either unsaturated fat or protein. The lower carbohydrate diets improved the CVD risk factors. Several popular diets claiming health benefits emphasize carbohydrate, fat, or protein or various combined approaches.

Objective: The objective of this study was to compare the macronutrient contents of the OmniHeart trial diets to those of several popular diets and to evaluate each diet for consistency with national health guidelines.

Design: The macronutrient contents of 7-d menu plans from the OmniHeart Study, Dietary Approaches to Stop Hypertension (DASH), Zone, Atkins, Mediterranean, South Beach, and Ornish diets were evaluated for consistency with the US Food and Nutrition Board's Acceptable Macronutrient Distribution Ranges (AMDRs) and with the dietary recommendations of several health organizations.

Results: The OmniHeart diets fulfilled the major AMDRs, but, of the popular diets, only the Zone diet did. The OmniHeart diets were generally consistent with national guidelines to prevent cancer, diabetes, and heart disease, whereas most popular diets had limitations for fulfilling one or more guidelines.

Conclusions: Although the OmniHeart protein and unsaturated fat diets were superior to the carbohydrate diet in improving CVD risk, all 3 study diets were consistent with national guidelines to reduce chronic disease risk, which suggests that the guidelines might now be fine-tuned to optimize disease prevention. Popular diets vary in their nutritional adequacy and consistency with guidelines for risk reduction.

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Figures

FIGURE 1

FIGURE 1

Macronutrient profiles of popular diets, the OmniHeart and Dietary Approaches to Stop Hypertension (DASH) study diets, the American Heart Association Therapeutic Lifestyle (AHA TLC) guidelines (5), and typical US macronutrient intakes as reported in the third Health and Nutrition Examination Survey (NHANES III; 24). The eating patterns are ordered with the highest-carbohydrate diet starting on the left and the lowest on the right. The Atkins diet profile is for the life-long maintenance phase, and the South Beach diet profile is for phase 3. Small amounts of alcohol (0.2−0.8% of energy) were also present in the Ornish, Mediterranean, Atkins, Zone, and South Beach diets. Percentages may not add up to 100% because of rounding.

FIGURE 2

FIGURE 2

Comparison of the calculated macronutrient profiles (mean ± SEM) of various diet plans with the Institute of Medicine's Acceptable Macronutrient Distribution Ranges (AMDR). Solid horizontal lines represent the upper and lower limits of the AMDR for the macronutrient. ■, exceeds the AMDR; formula image, meets the AMDR; □, failed to reach the minimum AMDR. DASH, Dietary Approaches to Stop Hypertension.

FIGURE 3

FIGURE 3

Typical fatty acid profiles of popular diets, the OmniHeart and Dietary Approaches to Stop Hypertension (DASH) study diets, the American Heart Association Therapeutic Lifestyle (AHA TLC) guidelines (5), and typical US macronutrient intakes as reported in the third Health and Nutrition Examination Survey (NHANES III; 24) as “reference points.” Solid horizontal line represents the 7% upper level of intake for saturated fat proposed by the AHA; diets to the right of the vertical dashed line provided >35% of energy from total fat. The Ornish, Zone, DASH, and OmniHeart study diets provided ≤7% of energy from saturated fat; the South Beach (phase 3) and Mediterranean diets provided ≤11% of total energy from saturated fat. The Atkins profile is for the life-long maintenance phase and provided >20% of energy from saturated fat. Note that the sum of fatty acid classes may not add up to the total amount of fat, because total fat may include some non-fatty acid material, such as glycerol, phosphate, sugar, or sterol not analyzed in the foods.

FIGURE 4

FIGURE 4

Comparison between attrition rates in studies of the Atkins diets and in low-fat diets. Although early studies compared Atkins diets only to low-fat diets, later studies included other popular diets (, , , , –40). For studies that included other popular diets, we present the attrition rates in only the Atkins and low-fat (≤30% of energy) arms. The number of subjects randomly assigned to begin each diet is shown in the chart.

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