Hilel Vardi

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

BACKGROUND Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. METHODS In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. RESULTS The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels). CONCLUSIONS Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. (ClinicalTrials.gov number, NCT00160108.)

Obstetric outcome of singleton pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously

OBJECTIVE To compare the obstetric characteristics of singleton pregnancies conceived by IVF and ovulation induction with those conceived spontaneously. DESIGN Case-control study. SETTING Tertiary care medical center. PATIENT(S) All singleton pregnancies that were achieved by IVF (n = 169) and ovulation induction (n = 646) and were delivered from January 1989 through December 1994 were evaluated. Each group was compared with a separate control group that conceived spontaneously (n = 469 and n = 1,902 for the IVF and ovulation induction groups, respectively) and delivered during the same period and was matched in terms of maternal age, gestational age, and parity. INTERVENTION(S) Ovulation induction, IVF-ET. MAIN OUTCOME MEASURE(S) Obstetric complications. RESULT(S) Multivariate analysis showed that patients who conceived by IVF and ovulation induction had a significantly higher risk for gestational diabetes mellitus (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.23-3.30 and OR = 1.9, 95% CI = 1.09-1.79, respectively), pregnancy-induced hypertension (OR = 2.1, 95% CI = 1.04-4.10 and OR = 1.5, 95% CI = 1.04-2.02, respectively), and cesarean section (OR = 3.6, 95% CI = 2.44-5.29 and OR = 1.4, 95% CI = 1.09-1.79, respectively) compared with their matched controls. CONCLUSION(S) After controlling for maternal age, gestational age, and parity, we demonstrated that singleton pregnancies conceived by IVF and ovulation induction are at increased risk for maternal gestational diabetes mellitus and pregnancy-induced hypertension, and at greater risk for delivery by cesarean section.

Dietary intake and eating patterns of elderly people in Israel: who is at nutritional risk?

Objective: To determine dietary intake and eating patterns of older persons in Israel and to identify factors associated with low intake.Design: A cross-sectional study.Setting: Community-dwelling participants living in the Beer-Sheva area were interviewed at home, using a 24 h food questionnaire with additional questions regarding health and eating habits. Dietary intake was compared between people aged 65–74 and 75 y and older.Subjects: A total of 377 people over the age of 65 224 aged 65–74 and 153>75, were randomly selected from the Negev population.Results: Dietary intake of energy, fat, carbohydrates, vitamins E, C and B1 were significantly lower for people aged 75 and older compared with people aged 65–74. Low energy intake was associated with lower subjective health status for men (P<0.01), poor appetite (P<0.01) and more gastrointestinal problems (P<0.05) for women and lower snack consumption (P<0.01) for both genders. In a multivariate model, low energy intake was associated with low appetite and higher use of medication for both sexes and with frequency of eating alone and not consuming snacks for men.Conclusion: Dietary intake is lower among individuals older than 75 than in 65–74 y old. Risk factors for low intake include poor appetite and health status, gastrointestinal problems, and eating alone. Snacking enhanced dietary intake and should be encouraged in this group.Sponsorship: Goldman Fund for Ben-Gurion University of the Negev.

Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries

Background/ObjectivesThe Mediterranean diet (MEDDIET) has been shown to be related to longevity. This study aimed to determine the association between adherence to MEDDIET and physical function of older adults in the United-States and Israel.MethodsData from the US National Health and Nutrition Survey (NHANES) 1999–2002 and from the Israeli National Health and Nutrition Survey (MABAT ZAHAV) 2005–2006 were used. Participants with nutritional and functional data were included. Adherence to the MEDDIET was assessed by a 9-unit score (MDS).ResultsAmong 2791 NHANES and 1786 MABAT ZAHAV participants, mean age=71.2y and 74.9y, 20% and 27% had low MDS (0–2), 66% and 62% had a medium score (3–5), and 14% and 11% had a high score (6–9), respectively. Higher MDS was associated with higher education and better lifestyle behaviors. Cognitive and physical functions were significantly better in NHANES and MABAT ZAHAV among the highest MDS. In NHANES, MDS (high vs. low) was associated with faster walking speed after adjusting for confounders in a logistic regression model [Odds Ratio (OR)=0.71, P=0.034, Cl 95% 0.511–0.974]. When cognitive function was added, the association was attenuated (OR=0.75, P=0.093, Cl 95% 0.540–1.049). In MABAT ZAHAV, in a logistic regression model adjusted among other to cognitive function, MDS (high vs. low) was associated with fewer disabilities (OR=0.51, P=0.029, Cl 95% 0.276–0.934).ConclusionsAdherence to the MEDDIET is associated with better health characteristics and better functioning. Further cohort and intervention studies may shed light on temporal and causal relationships between MEDDIET and these parameters.

Effect of changes in the intake of weight of specific food groups on successful body weight loss during a multi-dietary strategy intervention trial.

Background: Distinct weight loss dietary strategies are associated with changes in specific food groups. Objective: To address the effect of changes in specific weight of food groups on weight loss in a 2-year low-fat, Mediterranean, low-carbohydrate intervention trial (DIRECT). Methods: We assessed changes in the intake of 12 food groups among 322 participants (body mass index [BMI] = 31 kg/m2; age = 52 years; 86% men), using a validated electronic food frequency questionnaire. Results: The weight of the 3592.9 ± 1558 (g/d ± SD) of baseline food consumed consisted mainly of liquids, excluding water (32.6% of total weight of food); vegetables (18.8%), fruits (17.7%), dairy (9.0%), meat (7.7%), and bread/cereal/pasta/potatoes (7.1%). Participants significantly reduced food intake by 283.73 ± 1342 (g/d ± SD) at 6 months and by 963.36 ± 1869 (g/d ± SD) at 24 months (p < 0.05 as compared with baseline). Food weight changes were similar across diet groups (p = 0.366), whereas 6-month body weight loss was −4.6 ± 4.4 kg, −4.7 ± 4.9 kg, and −6.4 ± 6.6 kg for low-fat, Mediterranean, and low-carbohydrate groups, respectively; p < 0.026). In multivariate regression models, adjusted for age, sex, baseline body weight, and changes in weight intake of 12 food groups (g/d), independent dietary predictors (standardized-β) at 6 months (rapid weight loss phase) were as follows: decreased consumption of sweets and cakes (β = 0.493; p = 0.008) in the low-fat group, tendency toward increased crude legumes (β = −0.196; p = 0.061) in the Mediterranean group, and increased vegetable intake (β = −0.249; p = 0.018) in the low-carbohydrate diet group. In the entire group, in models further adjusted for diet type, leading predictors for rapid weight loss phase were as follows: increased vegetables by ∼140 g/d (β = −0.116; p = 0.045) and decreased intake of sweets and cakes by ∼30 g/d (β = 0.162; p = 0.010). Universal predictors for 2-year successful weight loss in the entire group were as follows: increased intake of vegetables (β = −0.192; p = 0.007) and meat (β = −0.146; p = 0.026) and decreased intake of eggs (β = 0.187; p = 0.003), processed legumes (β = 0.195; p = 0.002), and beverages (β = 0.135; p = 0.032). Conclusions: Two-year weight loss is associated with a decrease of ∼1 kg of total food consumed and may be achieved by a variety of changes in specific food groups within different diet strategies. Universal predictors of successful weight loss in the rapid weight loss phase across all diet strategies are increasing the weight of intake of vegetables and decreasing the weight of intake of sweets and cakes.

Importance of ethnic foods as predictors of and contributors to nutrient intake levels in a minority population

Objectives:To evaluate the role of ethnic foods as predictors of intake levels of selected nutrients that are important during pregnancy among the Bedouin Arab minority population in southern Israel, and to compare the main food predictors for Bedouin intakes of the selected nutrients with those for the regions Jewish majority population.Subjects/Methods:Ethnic foods/recipes (n=122) reported in the Bedouin Nutrition Study (BNS) were added to a preexisting, validated Israeli food composition table using European Food Information Resource standard criteria. Food items reported by the 519 BNS participants were combined into146 food groups that distinguished between existing foods and new ethnic recipes and were entered into a stepwise multiple regression model to identify the main predictors of intake levels of the selected nutrients. The results were compared with those of an identical analysis for the selected nutrients using 24 h recall data from the majority Jewish population.Results:Over 80% of the BNS between-person variability in the intake of all selected nutrients was explained by 34 food groups, of which 13 (38.2%) were ethnic foods. Homemade whole wheat bread was a main predictor of intake levels for five of the eight selected nutrients, and other ethnic foods/recipes (for example, za’atar, leafy dark green vegetables and camel milk) emerged as predictors of iron, folate, calcium and ω-3 fatty acid intakes. Breads explained 60 and 44% of the between-person variation, and 38 and 36% of the total intakes of iron and zinc intakes in the BNS sample, respectively, whereas for the Jewish population, animal sources and fortified foods predominated as main predictors and contributors of these nutrients.Conclusions:The addition of ethnic foods to food composition databases is important, as some of these foods are main predictors of nutrient intake levels in ethnic minority populations. In turn, this should facilitate the development of more sensitive dietary assessment tools and more effective diet-based health interventions for ethnic minorities.

Differences in dietary consumption patterns and obesity rates between immigrants from the former USSR and a country’s native population

This study compared dietary intake, obesity rates and chronic disease prevalence between former USSR immigrants and the native Israeli population using random sample survey and dietary intake assessment. USSR immigrants had significantly higher BMI (27.6 ± 5.0 vs. 26.5 ± 4.7kg/m 2 , P = 0.002) despite lower energy intake (1547.8 ± 683.7 vs. 1714.4 ± 781.9 kcal, P = 0.002), less reported ‘good’ health status (51% vs. 74%, P < 0.01), and higher incidence of heart attack (17% vs. 9%, P < 0.01) and hypertension (37% vs. 24%, P < 0.01). They consumed significantly less vitamin D, iron, calcium, folate, riboflavin and sodium (P < 0.01) and significantly less vitamin C and E, B6, magnesium, phosphorus, zinc and niacin (P < 0.05). Immigration status and diseases were significant predictors for obesity (BMI ≥ 30 kg/m 2 , OR = 1.66, P = 0.003 and OR = 1.17, P = 0.01). Former USSR immigrants are at increased risk for obesity and other chronic diseases and should be encouraged to consume more green vegetables, to lower energy density.

Weight Loss With a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

ABSTRACTPrevious trials have shown that a low-carbohydrate diet high in fat and protein may result in weight loss and exert positive metabolic effects. The Mediterranean diet, with moderate fat and high in monounsaturated fat, provides cardiovascular benefits, but weight loss has not been documented