4. Discussion
obese, overweight, TG, weight loss
CVD, OBESE, METABOLIC DISORDERS
We chose two amounts of carbohydrate, 50 g and 120 g, as low-carbohydrate and very-low-carbohydrate diets, respectively. There is no evidence on the suitable amount of carbohydrate in dietary treatment for obese and overweight Japanese patients. A review published in 2015 [Moreover, even if the energy instructions and proportions of macronutrients are the same, different ingredients have different protein properties, which vary widely among fish, meat and vegetables. In the past, many trials [There were no significant differences between the LCD and VLCD groups in the change in body composition or change in body weight. Overall, both diets were safe and effective for two months. Moreover, there were no significant differences between the LCD and VLCD groups in the change in the levels of blood parameters during the time that the subjects received the fully-provided diet; however, the change in serum creatinine, eGFR, serum total ketone bodies, 3-OHBA and acetyl acetic acid level was greater in the VLCD group than in the LCD group. Serum creatinine and eGFR might be altered by the different effects of the two diets on the glomerular filtration rate, although we should be cautious in interpreting creatinine levels or eGFR change when there is a significant fluctuation in body weight. Acetyl acetic acid is a typical ketone body, and a very low carbohydrate intake might result in the production of large amounts of ketone bodies. Recently, growing evidence has suggested that elevated ketone bodies have various beneficial effects on health [The study meals were also intended to provide a low level of saturated fat, which may promote a more favorable CVD risk profile by elevating HDL-C and reducing TG levels, with comparable reductions in LDL-C, as previously reported [The questionnaire reflected a high desire to continue the diet in both the VLCD and LCD groups. There were also many statements recognizing weight loss, which may have increased self-esteem due to the achievement of weight loss. In prior studies [Various clinical studies have also shown the effectiveness of remote dietary intervention via mobile apps [The present study was associated with several limitations. The study population was limited, the study period was relatively short, and the participants could not be blinded due to the characteristics of dietary therapy. However, in this study, high compliance and dietary accuracy were achieved for the first time for obese subjects through meal provision and smartphone follow-up. Intervention provided by high-level professional support and the assistance of the dietary offerings that promoted high compliance was cooperative, and the objective of establishing the characteristics of a low-carbohydrate diet when accompanied by adequate intervention appears to have been achieved.In conclusion, the present study demonstrated that the intake of an LCD (120 g carbohydrate/day) or VLCD (50 g carbohydrate/day) for two months had similar efficacy and safety in Japanese obese and overweight subjects with metabolic disorders. Significant improvement was achieved in both groups, which suggests that an LCD may have advantageous therapeutic potential for Japanese overweight and obese individuals. Further research is required to establish the longer-term effects. 