Research Article| Volume 65, ISSUE 3, P235-241, September 2004

Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity


      The adequate composition of carbohydrate and fat in low calorie diets for type 2 diabetes mellitus patients with obesity is not fully established. The aim of this study was to investigate the effects of low carbohydrate diet on glucose and lipid metabolism, especially on visceral fat accumulation, and comparing that of a high carbohydrate diet. Obese subjects with type 2 diabetes mellitus were randomly assigned to take a low calorie and low carbohydrate diet (n=11, 1000 kcal per day, protein:carbohydrate:fat=25:40:35) or a low calorie and high carbohydrate diet (n=11, 1000 kcal per day, protein:carbohydrate:fat=25:65:10) for 4 weeks. Similar decreases in body weight and serum glucose levels were observed in both groups. Fasting serum insulin levels were reduced in the low carbohydrate diet group compared to the high carbohydrate diet group (−30% versus −10%, P<0.05). Total serum cholesterol and triglyceride levels decreased in both groups, but were not significantly different from each other. High-density lipoprotein–cholesterol (HDL–C) increased in the low carbohydrate diet group but not in the high carbohydrate diet group (+15% versus 0%, P<0.01). There was a larger decrease in visceral fat area measured by computed tomography in the low carbohydrate diet group compared to the high carbohydrate diet group (−40 cm2 versus −10 cm2, P<0.05). The ratio of visceral fat area to subcutaneous fat area did not change in the high carbohydrate diet group (from 0.70 to 0.68), but it decreased significantly in the low carbohydrate diet group (from 0.69 to 0.47, P<0.05). These results suggest that, when restrict diet was made isocaloric, a low calorie/low carbohydrate diet might be more effective treatment for a reduction of visceral fat, improved insulin sensitivity and increased in HDL–C levels than low calorie/high carbohydrate diet in obese subjects with type 2 diabetes mellitus.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yamashita S.
        • Nakamura T.
        • Shimomura I.
        • Nishida M.
        • Yoshida S.
        • Kotani K.
        • Kameda K.
        • Tokunaga K.
        • Maatsuzawa Y.
        Insulin resistance and body fat distribution.
        Diab. Care. 1996; 19: 287-291
        • Evans D.J.
        • Hoffman R.G.
        • Kalkhoff R.K.
        • Kissebah A.H.
        Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women.
        Metabolism. 1984; 33: 68-75
        • Ducimetière P.
        • Richard J.
        • Cambien F.
        The pattern of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study.
        Int. J. Obes. 1986; 10: 229-240
        • Donahue R.P.
        • Abbott R.D.
        • Bloom E.
        • Reed D.M.
        • Yano K.
        Central obesity and coronary heart disease in men.
        Lancet. 1987; 4: 821-824
        • Rabast U.
        • Schonbörn J.
        • Kasper H.
        Diabetic treatment of obesity with low and high-carbohydrate diets: comparative studies and clinical results.
        Int. J. Obes. 1979; 3: 201-211
        • Yang M.U.
        • Itallie V.
        Composition of weight loss during short-term weight reduction.
        J. Clin. Invest. 1976; 58: 722-730
        • Werner S.B.
        Comparison between weight reduction on a high calorie high fat diet and on an isocaloric regimen high in carbohydrate.
        N. Eng. J. Med. 1955; 66: 252
        • Zavaroni I.
        • Chen Y.D.
        • Reaven G.M.
        Studies of the mechanism of fructose-induced hypertriglyceridemia in the rat.
        Metabolism. 1982; 31: 1077-1083
        • Garg A.
        • Bantle J.P.
        • Henry R.R.
        • Coulston A.M.
        • Griver K.A.
        • Huet B.A.
        • Reaven G.M.
        Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus.
        JAMA. 1994; 271: 1421-1428
        • Miyashita Y.
        • Itoh Y.
        • Hashiguchi S.
        • Totsuka M.
        • Murano T.
        • Ariga K.
        • Uetake T.
        • Nagai C.
        • Tomioka H.
        • Shirai K.
        Effects of low carbohydrate content of low calory diet for obese non-insulin-dependent diabetes mellitus patients on glucose and lipid metabolism.
        J. Jpn. Diab. Soc. 1998; 41: 885-890
        • Turner R.C.
        • Holman R.R.
        • Matthews D.
        • Hockaday T.D.
        • Peto J.
        Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations.
        Metabolism. 1979; 11: 1086-1096
        • Staels B.
        • Dallongeville J.
        • Auwerx J.
        • Schoonjans K.
        • Leitersdorf E.
        • Fruchart J.C.
        Mechanism of action of fibrates on lipid and lipoprotein metabolism.
        Circulation. 1998; 19: 2088-2093
        • Mead J.R.
        • Irvine S.A.
        • Ramji D.P.
        Lipoprotein lipase: structure, function, regulation, and role in disease.
        J. Mol. Med. 2002; 80: 753-769
        • Pulawa L.K.
        • Eckel R.H.
        Over expression of muscle lipoprotein lipase and insulin sensitivity.
        Curr. Opin. Clin. Nutr. Metab. Care. 2002; 5: 569-574
        • Langfort J.L.
        • Zarzeczny R.
        • Nazar K.
        • Kaciuba-Uscilko H.
        The effect of low-carbohydrate diet on the pattern of hormonal changes during incremental, graded exercise in young men.
        Int. J. Sport Nutr. Exerc. Metab. 2001; 11: 248-257
        • Itoh Y.
        • Shiai K.
        Preferential lipolysis in rat visceral adipose tissues by growth hormone.
        Endocrinol. Metab. 1997; 4: 61-67
        • Lucidi P.
        • Parlanti N.
        • Piccioni F.
        • Snateusanio F.
        • De Feo P.
        Short-term treatment with low doses of recombinant human GH stimulates lipolysis in visceral obese men.
        J. Clin. Endocrinol. Metab. 2002; 87: 3105-3109
        • Boyko E.J.
        • Leonetti D.L.
        • Bergstrom R.W.
        • Newell-Morris L.
        • Fujimoto W.Y.
        Low insulin secretion and high fasting insulin and C-peptide levels predict increased visceral adiposity. %-year follow-up among initially nondiabetic Japanese-American men.
        Diabetes. 1996; 45: 1010-1015
        • Rebuffe-Scrive M.
        • Anderson B.
        • Olbe L.
        • Bjorntorp P.
        Metabolism of adipose tissue in intraabdominal deposits in severely obese men and women.
        Metabolism. 1990; 39: 570-574
        • Svedberg J.
        • Bjomtorp P.
        • Smith U.
        • Lonnroth P.
        Free-fatty acid inhibition of insulin binding, degradation, and action in isolated rat hepatocytes.
        Diabetes. 1990; 39: 570-574
        • Reaven G.M.
        The role of insulin resistance and hyperinsulinemia in coronary heart disease.
        Metabolism. 1992; 41: 16-19
        • Stout R.W.
        Insulin and atheroma: 20-year perspective.
        Diab. Care. 1990; 13: 631-654
        • Gang A.
        • Bonanome A.
        • Grundy S.M.
        • Zhang Z.J.
        • Unger R.H.
        Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus.
        N. Engl. J. Med. 1988; 319: 829-834
        • Parillo M.
        • Rivellese A.A.
        • Ciardullo A.V.
        A high-monounsaturated-fat/low-carbohydrate diet improves peripheral insulin sensitivity in non-insulin-dependent diabetic patients.
        Metabolism. 1992; 41: 1373-1378