Diets with increased protein and reduced carbohydrates (PRO) are effective for weight loss, but the long-term effect on maintenance is unknown. This study compared changes in body weight and composition and blood lipids after short-term weight loss (4 mo) followed by weight maintenance (8 mo) using moderate PRO or conventional high-carbohydrate (CHO) diets. Participants (age = 45.4 +/- 1.2 y; BMI = 32.6 +/- 0.8 kg/m(2); n = 130) were randomized to 2 energy-restricted diets (-500 kcal/d or -2093 kJ/d): PRO with 1.6 g x kg(-1) x d(-1) protein and <170 g/d carbohydrates or CHO with 0.8 g x kg(-1) x d(-1) protein, >220 g/d carbohydrates. At 4 mo, the PRO group had lost 22% more fat mass (FM) (-5.6 +/- 0.4 kg) than the CHO group (-4.6 +/- 0.3 kg) but weight loss did not differ between groups (-8.2 +/- 0.5 kg vs. -7.0 +/- 0.5 kg; P = 0.10). At 12 mo, the PRO group had more participants complete the study (64 vs. 45%, P < 0.05) with greater improvement in body composition; however, weight loss did not differ between groups (-10.4 +/- 1.2 kg vs. -8.4 +/- 0.9 kg; P = 0.18). Using a compliance criterion of participants attaining >10% weight loss, the PRO group had more participants (31 vs. 21%) lose more weight (-16.5 +/- 1.5 vs. -12.3 +/- 0.9 kg; P < 0.01) and FM (-11.7 +/- 1.0 vs. -7.9 +/- 0.7 kg; P < 0.01) than the CHO group. The CHO diet reduced serum cholesterol and LDL cholesterol compared with PRO (P < 0.01) at 4 mo, but the effect did not remain at 12 mo. PRO had sustained favorable effects on serum triacylglycerol (TAG), HDL cholesterol (HDL-C), and TAG:HDL-C compared with CHO at 4 and 12 mo (P < 0.01). The PRO diet was more effective for FM loss and body composition improvement during initial weight loss and long-term maintenance and produced sustained reductions in TAG and increases in HDL-C compared with the CHO diet.

While not different from low-income families who do not report food insufficiency, low-income families with food insufficiency had children who differed from high-income families in several nutrition and anthropometric measures. Clinicians should be aware of the possible effects of poverty and lack of access to food on child health and nutrition status. The long-term effects of these are not yet known.

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