Work

Testing the carbohydrate-insulin model of obesity in a 5-month feeding study: the perils of post-hoc participant exclusions

Year: 2020

Type: article

Abstract: A large feeding study reported that total energy expenditure (TEE) was greater on a low- versus high-carbohydrate diet, supporting the carbohydrate-insulin model of obesity. Recently, the validity of this finding was challenged in a post-hoc analysis excluding participants with putative non-adherence to the study diets. Here, we show why that analysis, based on a post-randomization variable linked to the outcome, introduced severe confounding bias. With control for confounding, the diet effect on TEE remained strong in a reanalysis. Together with sensitivity analyses demonstrating robustness to plausible levels of non-adherence, these data provide experimental support for a potentially novel metabolic effect of macronutrients that might inform the design of more effective obesity treatment.

Source: European Journal of Clinical Nutrition

DOI: 10.1038/s41430-020-0658-8

Authors: David S. Ludwig, Kimberly F. Greco, Clement Ma, Cara B. Ebbeling

Institutions: Boston Children's Hospital, Harvard University, Dana-Farber/Boston Children's Cancer and Blood Disorders Center

Language: English

Topic: Diet and metabolism studies

Subfield: Physiology (medical)

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,860