To the Editor.
—The study design and results in the article by Dr Garg and colleagues1 do not support their conclusion that most patients with NIDDM would benefit, at least in the short term, by preferentially consuming a diet high in monounsaturated fatty acids (45% of energy from fat, 40% from carbohydrate) in lieu of a diet high in complex carbohydrates (30% of energy from fat, 55% from carbohydrates). The uncontrolled energy manipulations in the middle of the trial vitiated the original experiment. In light of the changes in energy intake required of the study participants in order to maintain constant body weight, it is reasonable and more parsimonious to speculate that the plasma triglyceride changes observed in this trial might be attributed largely to energy restriction (especially carbohydrate energy restriction) in the higher-fat condition2 and/or consumption of energy (specifically, the carbohydrate energy) in excess of appetite in
McCarthy WJ, Inkeles S. Varying Carbohydrate Intake in NIDDM. JAMA. 1994;272(23):1817-1818. doi:10.1001/jama.1994.03520230027018