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Clinical Research

Effect of low-carbohydrate vs low-fat diet intervention on visceral fat estimated from dual energy X-ray absorptiometry in a 12-month randomized controlled trial

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Background

A healthy low-fat (HLF) and healthy low-carbohydrate (HLC) diet are common strategies for weight loss that vary in their effects on adiposity and metabolism. Visceral adipose tissue (VAT) is the major contributor to metabolism deregulation, beyond subcutaneous adipose tissue (SAT). Despite strong biological evidence that a HLC diet preferentially decreases VAT, the difficulty measuring it has impeded diet trials. We estimated VAT and SAT in the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) weight loss trial to compare the effects of HLF and HLC diets and effect modification by sex and insulin resistance.

Methods

In a 1-year weight loss trial, DIETFITS, we compared VAT loss between HLF and HLC diets by randomizing N = 609 adults to either diet. VAT was estimated using dual-energy x-ray absorptiometry at baseline, 6 months, and 12 months. Linear mixed models analyzed associations between diet and VAT. We built separate models to evaluate effect modification by sex and insulin resistance.

Results

Among 449 participants (60% women; mean age 39 years), VAT loss was significantly greater for those eating the HLC diet compared to the HLF diet at 6 months [10.6 cm2; 95% confidence interval (CI): 5,16.2] and 12 months (6.3 cm2; 95% CI: 0.6,12). VAT relative to SAT loss estimates were greater in the HLC diet at 6 months only. Men experienced greater HLC diet-induced VAT loss than did women. Insulin secretion status did not modify VAT loss.

Conclusions

The HLC diet was associated with greater VAT loss compared to the HLF diet over 12 months. The loss of metabolically harmful VAT was independent from SAT over 6 months. Direct estimation of adipose sub-types provides strong evidence that insulin resistance does not modulate diet response. Sex differences should be considered in effective dietary interventions targeting VAT reduction and metabolic health.

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Fig. 1
Fig. 2: Estimated effect of healthy low-carbohydrate (HLC) and healthy low-fat (HLF) diets on visceral fat area (cm2) over time with 95% confidence intervals (error bars) from the primary mixed effects model.

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Data availability

The data that support the findings of this study are available from the senior author, CDG, upon reasonable request.

References

  1. Landry MJ, Crimarco A, Gardner CD. Benefits of low carbohydrate diets: a settled question or still controversial? Curr Obes Rep. 2021;10:409–22.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gardner CD, Trepanowski JF, Gobbo LCD, Hauser ME, Rigdon J, Ioannidis JPA, et al. Effect of low-fat VS low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion, the DIETFITS randomized clinical trial. J Am Med Assoc. 2018;319:667–79.

    Article  CAS  Google Scholar 

  3. Landry MJ, Ward CP, Cunanan KM, Fielding-Singh P, Crimarco A, Gardner CD. Switching diets after 6-months does not result in renewed weight loss: a secondary analysis of a 12-month crossover randomized trial. Sci Rep. 2024;14:9865. Apr 29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7:715–25.

    Article  PubMed  Google Scholar 

  5. Wajchenburg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738.

    Article  Google Scholar 

  6. Ludwig DS, Aronne LJ, Astrup A, de Cabo R, Cantley LC, Friedman MI, et al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr. 2021;114:1873–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Goss AM, Gower B, Soleymani T, Stewart M, Pendergrass M, Lockhart M, et al. Effects of weight loss during a very low carbohydrate diet on specific adipose tissue depots and insulin sensitivity in older adults with obesity: a randomized clinical trial. Nutr Metab. 2020;17:64.

    Article  CAS  Google Scholar 

  8. Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes. 2008;32:619–28.

    Article  CAS  Google Scholar 

  9. Garr Barry V, Stewart M, Soleymani T, Desmond RA, Goss AM, Gower BA. Greater loss of central adiposity from low-carbohydrate versus low-fat diet in middle-aged adults with overweight and obesity. Nutrients. 2021;13:475.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Aronica L, Rigdon J, Offringa LC, Stefanick ML, Gardner CD. Examining differences between overweight women and men in 12-month weight loss study comparing healthy low-carbohydrate vs. low-fat diets. Int J Obes. 2021;45:225–34.

    Article  CAS  Google Scholar 

  11. Bea JW, Chen Z, Blew RM, Nicholas JS, Follis S, Bland VL et al. MRI-based validation of abdominal adipose tissue measurements from DXA in postmenopausal women. J Clin Densitom. 2021;S1094695021000640.

  12. Schielzeth H, Dingemanse NJ, Nakagawa S, Westneat DF, Allegue H, Teplitsky C, et al. Robustness of linear mixed-effects models to violations of distributional assumptions. Sutherland C, editor. Methods Ecol Evol. 2020;11:1141–52.

    Article  Google Scholar 

  13. Wachsmuth NB, Aberer F, Haupt S, Schierbauer JR, Zimmer RT, Eckstein ML, et al. The impact of a high-carbohydrate/low fat vs. low-carbohydrate diet on performance and body composition in physically active adults: a cross-over controlled trial. Nutrients. 2022;14:423.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Fischer K, Pick JA, Moewes D, Nöthlings U. Qualitative aspects of diet affecting visceral and subcutaneous abdominal adipose tissue: a systematic review of observational and controlled intervention studies. Nutr Rev. 2015;73:191–215.

    Article  PubMed  Google Scholar 

  15. Allison DB, Paultre F, Goran MI, Poehlman ET, Heymsfield SB. Statistical considerations regarding the use of ratios to adjust data. Int J Obes Relat Metab Disord. 1995;19:644–52.

    CAS  PubMed  Google Scholar 

  16. Frank AP, De Souza Santos R, Palmer BF, Clegg DJ. Determinants of body fat distribution in humans may provide insight about obesity-related health risks. J Lipid Res. 2019;60:1710–9.

    Article  CAS  PubMed  Google Scholar 

  17. Sasakabe T, Haimoto H, Umegaki H, Wakai K. Association of decrease in carbohydrate intake with reduction in abdominal fat during 3-month moderate low-carbohydrate diet among non-obese Japanese patients with type 2 diabetes. Metabolism. 2015;64:618–25.

    Article  CAS  PubMed  Google Scholar 

  18. Li X, Perelman D, Leong AK, Fragiadakis G, Gardner CD, Snyder MP. Distinct factors associated with short-term and long-term weight loss induced by low-fat or low-carbohydrate diet intervention. Cell Rep Med. 2022;3:100870.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the Gardner research team from the parent DIETFITS study. We thank Kyla Kent and Vincent Busque, who contributed to the re-analysis of the DXA scans and Christopher Dant for his editorial review. We also thank the study participants for contributing their time and effort to this study. This research was supported by grant K99HL169908 (Follis) from the National Heart, Lung, and Blood Institute.

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Authors and Affiliations

  1. Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA

    Shawna Follis

  2. Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, CA, USA

    Matthew J. Landry

  3. Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford, CA, USA

    Kristen May Cunanan

  4. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA

    Marcia L. Stefanick, Catherine P. Ward & Christopher D. Gardner

Authors
  1. Shawna Follis
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  2. Matthew J. Landry
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  3. Kristen May Cunanan
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  4. Marcia L. Stefanick
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  5. Catherine P. Ward
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  6. Christopher D. Gardner
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Contributions

SF and CDG contributed to the conception; acquisition, analysis, interpretation, drafting; KMC contributed to the analysis, interpretation, drafting; MJL, MLS, and CPW contributed to the interpretation and drafting.

Corresponding author

Correspondence to Shawna Follis.

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Follis, S., Landry, M.J., Cunanan, K.M. et al. Effect of low-carbohydrate vs low-fat diet intervention on visceral fat estimated from dual energy X-ray absorptiometry in a 12-month randomized controlled trial. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01989-x

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