- Little is known about the potential adherence to and the effectiveness of a low-carbohydrate (LC) diet on weight loss and cardiometabolic risk factors in Chinese adults with a habitually high carbohydrate intake. In the present controlled feeding trial, fifty overweight or obese women (age 47·9 (sem 0·9) years; BMI 26·7 (sem 0·3) kg/m2) were randomly assigned to a LC non-energy-restricted diet (initial carbohydrate intake 20 g/d, with a 10 g increase weekly) or an energy-restricted (ER) diet (carbohydrate intake 156-205 g/d, ER to 5021 or 6276 kJ/d, 35 % average energy reduction) for 12 weeks. Over the intervention period, the two diets had comparable compliance (96 %) and self-reported acceptability. At week 12, carbohydrate intake in the LC and ER groups contributed to 36·1 and 51·1 % of total energy, respectively (P< 0·001). Although both diets showed similarly decreased mean body weight (LC - 5·27 (95 % CI - 6·08, - 4·46) kg; ER - 5·09 (95 % CI - 5·50, - 4·67) kg, P= 0·67) and percentage of fat mass measured by dual-energy X-ray absorptiometry (LC - 1·19 (95 % CI - 1·88, - 0·50) %; ER - 1·56 (95 % CI - 2·20, - 0·92) %, P= 0·42), participants in the LC group had greater reductions in the ratio of total cholesterol:HDL-cholesterol (P= 0·03) and also in the ratio of TAG:HDL-cholesterol (P= 0·01) than those in the ER group. The present 12-week diet trial suggested that both a LC non-energy-restricted diet and an ER diet were acceptable to Chinese women and both diets were equally effective in reducing weight and fat mass. Moreover, the LC diet showed beneficial effects on blood lipid profiles.