Risks For Obesity Diabetes And Cardiovascular Disease 41 Obesity

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Obesity is a major public health problem in the United States, with an increasing prevalence in both adults (37,38) and children (39). Obesity increases the risk of morbidity and mortality from associated diseases such as diabetes, hypertension, coronary heart disease, and cancer (40-42). Diets have been the traditional approach to dealing with excessive weight. Robert Atkins (43) popularized the use of the ketogenic diet to deal with weight gain. This type of ketogenic diet is a low-carbohydrate but high-protein formulation and consequently is fundamentally different from diets used for seizure control.

The Atkins diet is based on the premise that control of insulin is essential for weight loss and associated beneficial effects in reduction of diabetes and cardiovascular risk. By reducing carbohydrate intake to a negligible level, the diet attempts to eliminate insulin fluctuations that might occur after a typical meal. It is important to note that while this diet does not limit protein intake, many amino acids can be incorporated into the glycolysis pathways and thus can influence insulin secretion. However, this is not true for fatty acids. Consequently, a low-protein ketogenic diet is more likely to achieve the hypothesized goals of the Atkins diet than the widely used Atkins-type diet itself.

Weight loss with Atkins-type diets appears to be comparable to conventional hypocaloric diets in adults (mean loss of 5 kg in 12 wk) (44). Adolescents may respond better to a very-low-calorie KD than to a low-calorie nonketogenic diet (average loss of 15.4 kg over 8 wk on the KD vs 2.3 kg over 12 wk on a low-calorie nonketogenic diet) (45). Weight loss may also occur when the diet is intended to be isocaloric to the baseline diet (46,47). In addition to the reduction of carbohydrates, the type of fat consumed may be important.

Papamandjaris et al. (48) proposed that medium-chain fatty acids may hold more potential for weight loss than long-chain fatty acids, since the former are metabolized preferentially in the mitochondria and are associated with a postprandial increase in energy expenditure.

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