Effects of ketogenic and low-carbohydrate diets on the body composition of adults with overweight or obesity: A systematic review and meta-analysis of randomised controlled trials

IF 7.4 2区 医学 Q1 NUTRITION & DIETETICS Clinical nutrition Pub Date : 2025-03-01 Epub Date: 2025-01-18 DOI:10.1016/j.clnu.2025.01.017
Leona Yuen-Ling Leung , Hon-Lon Tam , Jonathan Ka-Ming Ho
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Abstract

Background and aims

More than one-third of individuals are overweight and obese in the world. Their risks of chronic health conditions are increased, which places additional burden on their family, caregivers, and healthcare system. Dietary modification is widely used for overweight and obese individuals. We investigated the effects of ketogenic diet (KD) and low-carbohydrate diet (LCD) in improving body weight (BW), body mass index (BMI), fat mass (FM), and body fat percentage (BFP) in overweight or obese individuals.

Methods

A three-step approach was adopted for searching relevant randomised controlled trials (RCTs) across five electronic databases. Two reviewers conducted the screening, review, and quality appraisal independently. A random-effects model was used because of variations in intervention and participant characteristics. Sensitivity and subgroup analyses were conducted to assess heterogeneity and variations in the results, respectively.

Results

Thirty-three RCTs involving 2821 individuals were included. Overall meta-analysis results indicated that KD/LCD significantly reduced BW, BMI, and BFP, but not FM, in individuals with a carbohydrate intake of ≤100 g/d. Subgroup analyses revealed significant improvements in BW, BMI, and FM in individuals on KD/LCD for ≥1 month and in all parameters for those with a carbohydrate intake of ≤50 g/d. High statistical heterogeneity was noted because of variations in interventions and participant characteristics.

Conclusion

Adults with overweight or obesity should consume KD/LCD for ≥1 month and limit carbohydrate intake to ≤50 g/d. Further multicentre or multicountry RCTs are needed to improve the generalisability of our findings. We recommend integrating text messaging and evidence-based information to support interventions and ensuring stringent medical supervision throughout the intervention.

PROSPERO registration number

CRD42022353074.
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生酮和低碳水化合物饮食对超重或肥胖成人身体组成的影响:随机对照试验的系统回顾和荟萃分析
背景和目的:世界上超过三分之一的人超重和肥胖。他们患慢性疾病的风险增加,这给他们的家庭、照顾者和卫生保健系统带来了额外的负担。饮食调整被广泛用于超重和肥胖人群。我们研究了生酮饮食(KD)和低碳水化合物饮食(LCD)对超重或肥胖个体体重(BW)、体重指数(BMI)、脂肪质量(FM)和体脂率(BFP)的改善作用。方法:采用三步法在5个电子数据库中检索相关随机对照试验(RCTs)。两名评审人员独立进行筛选、评审和质量评价。由于干预措施和参与者特征的差异,采用了随机效应模型。分别进行敏感性分析和亚组分析来评估结果的异质性和差异性。结果:共纳入33项随机对照试验,共2821人。总体荟萃分析结果显示,在碳水化合物摄入量≤100 g/d的个体中,KD/LCD显著降低了体重、BMI和BFP,但没有降低FM。亚组分析显示,服用KD/LCD≥1个月的个体的体重、BMI和FM以及碳水化合物摄入量≤50 g/d的所有参数均有显著改善。由于干预措施和参与者特征的差异,统计异质性很高。结论:超重或肥胖的成年人应持续摄入KD/LCD≥1个月,并将碳水化合物摄入量限制在≤50 g/d。需要进一步的多中心或多国随机对照试验来提高我们研究结果的普遍性。我们建议将短信和循证信息结合起来,以支持干预措施,并确保在整个干预过程中进行严格的医疗监督。普洛斯彼罗注册号:CRD42022353074。
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来源期刊
Clinical nutrition
Clinical nutrition 医学-营养学
CiteScore
14.10
自引率
6.30%
发文量
356
审稿时长
28 days
期刊介绍: Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.
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