Research| Volume 103, ISSUE 12, P1600-1606, December 2003

Download started.


An ad libitum, very low-fat diet results in weight loss and changes in nutrient intakes in postmenopausal women



      To determine whether a very low-fat diet (<15% of energy intake) consumed ad libitum during an 8-month period can achieve weight loss of 5% to 10% of initial body weight while still providing adequate intakes of other essential nutrients.


      Longitudinal, 8-month, ad libitum, free living, very low-fat diet trial.


      Fifty-four of the sixty-four healthy postmenopausal women recruited completed the entire study (age 59±8 years, BMI=29.6±6.3). Twenty-four of these women used hormone replacement therapy, thirty women did not.


      Weekly sessions aimed at teaching and reinforcing a very low-fat intake diet for eight months.


      outcome measures Body weight, percent body fat, waist-to-hip ratio, resting energy expenditure, respiratory quotient, and nutrient intakes derived from 7-day food records at the beginning and at 2, 4, 6, and 8 months of the study.

      Statistical analysis performed

      Repeated measures analysis of variance and Tukey post hoc analysis were used to analyze significant differences in mean data (P< .05).


      Fat intake decreased from 33.2±7.5% to 11±4% over the 8-month intervention period (P<.00001). Weight loss was 6.0 kg± 4.2 kg (P<.000038), an 8% weight change, and decrease in percent body fat of 2.7%±0.2% (P≤.000046). Weight correlated better with the self-reported fat intake (r=0.321, P<.01) than the energy intake (r=0.263, P<.05) at baseline. Fiber intake increased from 16 g±0.6 g to 23 g±0.2 g (P<.0005). All micronutrient intakes remained at or above preintervention ranges, except for a decrease in vitamin E intake from 8.1 mg±4.0 mg to 3.7 mg±1.1 mg (P<.0005) on the very low-fat diet and linoleic acid from 6.3%±1.5% to 2.5%±0.7% (P<.000001) with no significant reduction in linolenic acid. Hormone replacement was not associated with the amount of weight loss.


      This study demonstrates that adherence to a very low-fat diet consumed ad libitum causes weight loss in the 5% to 10% range and a reduction of body fat. These reductions, along with the observed decreases in fat intake, are associated with improved health outcomes. Because of the decreased vitamin E and n-3 fatty acid intake, emphasis on foods high in these nutrients may need to be encouraged for those consuming a very low-fat diet.
      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 Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jaquier E.
        Pathways to obesity.
        Int J Obes. 2002; 26: S12-S19
        • Astrup A.
        The role of dietary fat.
        Int J Obes. 2001; 25: 546-550
        • Bray C.A.
        • Popkin B.M.
        Dietary fat does affect obesity.
        Am J Clin Nutr. 1998; 68: 1157-1173
        • Insull W.
        • Henderson M.M.
        • Prentice R.L.
        • Thompson D.J.
        • Clifford C.
        • Goldman S.
        • Gorbach S.
        • Moskowitz M.
        • Thompson R.
        • Wood M.
        Results of a randomized feasibility study of a low-fat diet.
        Arch Intern Med. 1990; 150: 421-427
        • Lissner L.
        • Levitsky D.A.
        • Strupp B.J.
        • Kalkwarf H.J.
        • Roe D.A.
        Dietary fat and the regulation of energy intake in human subjects.
        Am J Clin Nutr. 1987; 46: 886-892
        • Kendall A.
        • Levitsky D.A.
        • Strupp B.J.
        • Lissner L.
        Weight loss on a low-fat diet.
        Am J Clin Nutr. 1991; 53: 1124-1129
        • Poppitt S.D.
        • Keogh G.F.
        • Prentice A.M.
        • Williams D.E.M.
        • Sonnemans H.M.W.
        • Valk E.E.J.
        • Robinson E.
        • Wareham N.J.
        Long term effects of ad libitum lowfat high carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome.
        Am J Clin Nutr. 2002; 75: 11-20
        • Prewitt T.E.
        • Schmeisser D.
        • Bower P.E.
        • Aye P.
        • Dolecek T.A.
        • Langenberg P.
        • Cole T.
        • Brace L.
        Changes in body weight, body composition, and energy intake in women fed high- and low-fat diets.
        Am J Clin Nutr. 1991; 54: 304-310
        • Schaefer E.J.
        • Lichtenstein A.H.
        • Lamon-Fava S.
        • McNamara J.R.
        • Schaefer M.M.
        • Rasmussen H.
        • Ordovas J.M.
        Body weight and low density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet.
        JAMA. 1995; 274: 1450-1455
        • Westerterp K.R.
        • Verbueket-van de Venne V.P.
        • Westerterp-Plantenga M.S.
        • Velthuis-te Wierik E.J.
        • de Graaf C.
        • Weststrate J.A.
        Dietary fat and body fat.
        Int J Obes Relat Metab Disord. 1996; 20: 1022-1026
        • Sheppard L.
        • Kristal A.R.
        • Kushi L.H.
        Weight loss in women participating in a randomized trial of low-fat diets.
        Am J Clin Nutr. 1991; 54: 821-828
        • Stubbs R.J.
        • William P.R.
        • Coward W.A.
        • Prentice A.M.
        Convert manipulation of the ratio of dietary fat to carbohydrate and energy density.
        Am J Clin Nutr. 1995; 62: 330-337
        • Thomas C.D.
        • Peters J.C.
        • Reed G.W.
        • Abumrad N.N.
        • Sun M.
        • Hill J.O.
        Nutrient balance and energy expenditure during ad libitum feeding of high-fat and high-carbohydrtate diets in humans.
        Am J Clin Nutr. 1992; 55: 934-942
        • Liu G.C.
        • Coulston A.M.
        • Lardinois C.K.
        • Hollenbeck C.B.
        • Moore J.G.
        • Reaven G.M.
        Moderate weight loss and sulfonylurea treatement of non-insulin-dependent diabetes mellitus. Combined effects.
        Arch Intern Med. 1985; 145: 665-669
      1. Beneficial effect of moderate weight loss in older patients with non-insulin-dependent diabetes mellitus poorly controlled with insulin.
        J Am Geriatr Soc. 1985; 33: 93-95
        • Wing R.R.
        • Koeske R.
        • Epstein L.H.
        • Nowalk M.P.
        • Gooding W.
        • Becker D.
        Long-term effects of modest weight loss in type II diabetic patients.
        Arch Intern Med. 1987; 147: 1749-1753
        • Wing R.R.
        • Jeffery R.W.
        Effect of modest weight loss on changes in cardiovascular risk factors.
        Int J Obes. 1995; 19: 67-73
        • De Simone G.
        • Mancini G.
        • Mainenti G.
        • Turco M.
        • Ferrara L.A.
        Weight reduction lowers blood pressure independently of salt restriction.
        J Endocrinol Invest. 1992; 15: 339-343
        • Reisin E.
        • Abel R.
        • Modan M.
        • Silverberg D.S.
        • Eliahou E.E.
        • Modan B.
        Effects of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients.
        N Engl J Med. 1978; 289: 1-6
        • McManus K.
        • Antinoro L.
        • Sacks F.
        A randomized controlled trial of moderate fat, low energy diet compared with a low fat, low energy diet for weight loss in overweight adults.
        Int J Obes Relat Metab Disord. 2001; 25: 1503-1511
        • Turley M.L.
        • Skeaff C.M.
        • Man J.I.
        • Cox B.
        The effect of a low-fat, high-carbohydrate diet on serum high density lipoprotein cholesterol and triglyceride.
        Eur J Clin Nutr. 1998; 52: 728-732
        • Swinburn B.A.
        • Woollard G.A.
        • Chang E.C.
        • Wilson M.R.
        Effects of reduced-fat diets consumed ad libitum on intake of nutrients, particularly antioxidant vitamins.
        J Am Diet Assoc. 1999; 99: 1400-1405
        • Pi-Sunyer F.X.
        Weight and non-insulin-dependent diabetes mellitus.
        Am J Clin Nutr. 1996; 63: 426S-429S
        • Garrison R.J.
        • Higgins M.W.
        • Kannel W.B.
        Obesity and coronary heart disease.
        Curr Opin Lipidol. 1996; 7: 199-202
        • Velthuis-te Wierik E.J.
        • van den Berg H.
        • Weststrates J.A.
        • van het Hof K.T.
        • de Graaf C.
        Consumption of reduced-fat products.
        Eur J Clin Nutr. 1996; 50: 214-219
        • Willett W.C.
        Diet and Health.
        Science. 1994; 264: 532-537
        • Den Tonkelaar I.
        • Oddens B.J.
        Determinants of long-term hormone replacement therapy and reasons for early discontinuation.
        Obstet Gynecol. 2000; 95: 507-512
        • Sayegh R.A.
        • Kelly L.
        • Wurtman J.
        • Deitch A.
        • Chelmow D.
        Impact of hormone replacement therapy on the body mass and compositions of menopausal women.
        Menopause. 1999; 6: 312-315
        • Van Seumeren I.
        Weight gain and hormone replacement therapy.
        Maturitas. 2000; 34: S3-S8
        • Casabiell X.
        • Pineiro V.
        • Peino R.
        • Lage M.
        • Camina J.
        • Gallego R.
        • Vallejo L.G.
        • Dieguez C.
        • Casanueva F.F.
        Gender differences in both spontaneous and stimulated leptin secretion by human omental adipose tissue in vitro.
        J Clin Endocrinol Metab. 1998; 83: 2149-2155
        • Lusk G.
        Science of Nutrition. 4th ed. W. B. Saunders, Philadelphia1928: 65
        • Food and Nutrition Board
        Recommended Dietary Allowances. 10th ed. National Academy Press, Washington, DC1989
        • Valk E.E.
        • Hornstra G.
        Relationship between vitamin E requirement and polyunsaturated fatty acid intake in man.
        Int J Vitam Nutr Res. 2000; 70: 31-42
        • Krauss R.M.
        • Deckelbaum R.J.
        • Ernst N.
        • Fisher E.
        • Howard B.V.
        • Knopp R.H.
        • Kotchen T.
        • Lichtenstein A.H.
        • McGill H.C.
        • Pearson T.A.
        • Prewitt T.E.
        • Stone N.J.
        • Horn L.V.
        • Weinberg E.
        Dietary guidelines for healthy American adults.
        Circulation. 1996; 94: 1795-1800
      2. National Cholesterol Eduction Program Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).
        Circulation. 1994; 89: 1333-1445
        • Simopoulus A.P.
        Essential fatty acids in health and chronic disease.
        Am J Clin Nutr. 1999; 70: 560S-569S
        • Simopoulos A.P.
        • Leaf A.
        • Salem N.
        Workshop statement on the essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids.
        Prostaglandins, Leukot Essent Fatty Acids. 2000; 63: 119-121


      W. M. Mueller-Cunningham is an assistant professor, Department of Family & Consumer Sciences, and R. Quintana is an assistant professor, Department of Kinesiology, both at California State University of Sacramento, Sacramento.


      S. E. Kasim-Karakas is a professor, Department of Internal Medicine, Division of Endocrinology and Clinical Nutrition, School of Medicine, University of California at Davis, Davis.