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- Title
Testing the carbohydrate-insulin model of obesity in a 5-month feeding study: the perils of post-hoc participant exclusions.
- Authors
Ludwig, David S.; Greco, Kimberly F.; Ma, Clement; Ebbeling, Cara B.
- 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.
- Publication
European Journal of Clinical Nutrition, 2020, Vol 74, Issue 7, p1109
- ISSN
0954-3007
- Publication type
journal article
- DOI
10.1038/s41430-020-0658-8