"There are different types of weight control diets, according
to macronutrient composition. Many are low in carbohydrates
and high in protein, such as the Atkins diet (Volek and
Westman, 2002; Astrup et al., 2004; Lara-Castro and Garvey,
2004). Very-low-carbohydrate diets typically contain less
than 10% carbohydrates, 25–35% proteins and 55–65%
lipids. For comparison, the average American diet contains
35% lipids (85 g/day), 50% carbohydrates (275 g/day) and
15% protein (83 g/day) (CDC, 2004). In Great Britain, the
mean intake, as a percentage of total energy, is about 35%
lipids, of about 48% carbohydrates and about 17% protein
(Swan, 2004).
In our study population, consumption of
carbohydrates, even at the low extreme of the distribution,
was higher than that advocated by the prescribed lowcarbohydrate
diets and few individuals consumed more
than 20% of their energy from proteins. Nevertheless, it is
unlikely that at the extremes of the low-carbohydrate–highprotein
intake distribution there would be a reversal of the
trend evident in our study population. Indeed, many of
contemporary public health policies rely on extrapolations,
so that if something is detrimental at a certain exposure
level, its effect is likely to be more detrimental at a more
extreme level. The biology that underlines the positive
association of LC/HP diets with overall mortality is not
clear. It appears that high protein intake may be as important
as low-carbohydrate intake and the results of a recent study
(Kelemen et al., 2005) point to the same direction. Moreover,
the apparent detrimental effect of the LC/HP diet should not
be unexpected, in view of the fact that dietary scores that
have been reported to be associated with reduced mortality
are to a large extent ‘mirror idols’ to the LC/HP diets
(McCullough et al., 2002; Trichopoulou et al., 2003). In fact,
the Nutrition Committee of the Council on Nutrition,
Physical Activity, and Metabolism of the American Heart
Association has stated that high protein diets are not
recommended because they restrict healthful foods (St Jeor
et al., 2001)."
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