RANDOMIZED CROSSOVER STUDY OF 40-PERCENT VS 55-PERCENT CARBOHYDRATE WEIGHT-LOSS STRATEGIES IN WOMEN WITH PREVIOUS GESTATIONAL DIABETES-MELLITUS AND NONDIABETIC WOMEN OF 130-200-PERCENT IDEAL BODY-WEIGHT

Objective: The optimum diet composition for weight loss in obese women with or without previous gestational diabetes mellitus remains to be determined. Weight loss may be especially important for the latter gro up in terms of preventing future gestational as well as non-insulin de pendent diabetes mellitus. We studied 40% vs. 55% carbohydrate caloric ally restricted diets to compare weight loss and metabolic response. M ethods: We performed a prospective, 12-week, blinded, randomized cross over study of 25 obese women; 13 of whom had previous gestational diab etes. Each woman was allocated to a treatment regimen for 6 weeks and then ''crossed over'' to the alternative regimen for an additional 6 w eeks. Calories were provided in the form of nutritional supplement bar s except for the evening meal that comprised 1/3 of the caloric needs. All subjects were seen and weighed weekly. Metabolic variables includ ing glucose tolerance, glycated proteins, lipids, and percent body fat were measured at the beginning, crossover, and end of the study. Resu lts: Women with previous gestational diabetes mellitus were comparable to obese women without a history of previous gestational diabetes exc ept that the former had higher maximum levels of glucose on a glucose tolerance test and higher fasting insulin levels consistent with great er insulin resistance. Weight loss was comparable for all groups durin g the first 6 weeks but attenuated in all groups during the second 6 w eeks of the trial regardless of diabetes history or treatment group al location. Women with or without a previous history of gestational diab etes had higher triglycerides while on a 55% carbohydrate diet than wh ile on a 40% carbohydrate diet. Conclusions: A weight loss regimen con sisting of 40% carbohydrate results in lower triglyceride levels than those achieved with a 55% carbohydrate content diet in obese women. Th us, the hypocaloric diet with the higher Eat content produced the more favorable lipid profile in all obese women.