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Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials

  • Nassib Bezerra Bueno (a1), Ingrid Sofia Vieira de Melo (a1), Suzana Lima de Oliveira (a1) and Terezinha da Rocha Ataide (a1)
Abstract

The role of very-low-carbohydrate ketogenic diets (VLCKD) in the long-term management of obesity is not well established. The present meta-analysis aimed to investigate whether individuals assigned to a VLCKD (i.e. a diet with no more than 50 g carbohydrates/d) achieve better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional low-fat diet (LFD; i.e. a restricted-energy diet with less than 30 % of energy from fat). Through August 2012, MEDLINE, CENTRAL, ScienceDirect, Scopus, LILACS, SciELO, ClinicalTrials.gov and grey literature databases were searched, using no date or language restrictions, for randomised controlled trials that assigned adults to a VLCKD or a LFD, with 12 months or more of follow-up. The primary outcome was body weight. The secondary outcomes were TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), systolic and diastolic blood pressure, glucose, insulin, HbA1c and C-reactive protein levels. A total of thirteen studies met the inclusion/exclusion criteria. In the overall analysis, five outcomes revealed significant results. Individuals assigned to a VLCKD showed decreased body weight (weighted mean difference − 0·91 (95 % CI − 1·65, − 0·17) kg, 1415 patients), TAG (weighted mean difference − 0·18 (95 % CI − 0·27, − 0·08) mmol/l, 1258 patients) and diastolic blood pressure (weighted mean difference − 1·43 (95 % CI − 2·49, − 0·37) mmHg, 1298 patients) while increased HDL-C (weighted mean difference 0·09 (95 % CI 0·06, 0·12) mmol/l, 1257 patients) and LDL-C (weighted mean difference 0·12 (95 % CI 0·04, 0·2) mmol/l, 1255 patients). Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the long term; hence, a VLCKD may be an alternative tool against obesity.

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*Corresponding author: N. B. Bueno, email nassibbb@hotmail.com
References
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1World Health Organization (2012) Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed 10 May 2012).
2Gögebakan O, Kohl A, Osterhoff MA, et al. (2011) Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation 124, 28292838.
3Ornish D (1997) Every Day Cooking With Dean Ornish. New York: Harper Collins.
4Sears B & Lawren W (1995) Enter the Zone. New York: Harper Collins.
5Weight Watchers Publishing Group (1997) Weight Watchers New Complete Cookbook. New York: Macmill.
6Accurso A, Bernstein R, Dahlqvist A, et al. (2008) Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 5, 9.
7Alhassan S, Kim S, Bersamin A, et al. (2008) Dietary adherence and weight loss success among overweight women: results from the A to Z weight loss study. Int J Obes (Lond) 32, 985991.
8Sacks FM, Bray GA, Carey VJ, et al. (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360, 859873.
9Krieger JW, Sitren HS, Daniels MJ, et al. (2006) Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression. Am J Clin Nutr 83, 260274.
10Hession M, Rolland C, Kulkarni U, et al. (2009) Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 10, 3650.
11Nordmann AJ, Nordmann A, Briel M, et al. (2006) Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 166, 285293.
12Santos FL, Esteves SS, da Costa Pereira A, et al. (2012) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 13, 10481066.
13Moher D, Liberati A, Tetzlaff J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151, 264269.
14Sterne JAC, Egger M & Moher D (2011) Addressing reporting biases. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 10 March 2012).
15Robinson KA & Dickersin K (2002) Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol 31, 150153.
16World Health Organization Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157163.
17Higgins JPT & Deeks JJ (2011) Selecting studies and collecting data. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 22 March 2012).
18Higgins JPT, Altman DG & Sterne JAC (2011) Assessing risk of bias in included studies. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 21 March 2012).
19Deeks JJ, Higgins JPT & Altman DG (2011) Analysing data and undertaking meta-analyses. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 01 April 2012).
20DerSimonian R & Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7, 177188.
21Higgins JPT, Deeks JJ & Altman DG (2011) Special topics in statistics. In Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. http://www.cochrane-handbook.org (accessed 01 April 2012).
22Harbord RM & Higgins JPT (2008) Meta-regression in stata. Stata J 8, 493519.
23Peters JL, Sutton AJ, Jones DR, et al. (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61, 991996.
24Egger M, Smith GD, Schneider M, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.
25Vetter ML, Iqbal N, Volger S, et al. (2010) Long-term effects of low-carbohydrate versus low-fat diets in obese persons. Ann Int Med 152, 334335.
26Stern L, Iqbal N, Seshadri P, et al. (2004) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 140, 778785.
27Foster GD, Wyatt HR, Hill JO, et al. (2010) Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 153, 147157.
28Brinkworth GD, Noakes M, Buckley JD, et al. (2009) Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr 90, 2332.
29Iqbal N, Vetter ML, Moore RH, et al. (2010) Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants. Obesity (Silver Spring) 18, 17331738.
30Gardner CD, Kiazand A, Alhassan S, et al. (2007) Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A to Z Weight Loss Study: a randomized trial. JAMA 297, 969977.
31Ebbeling CB, Swain JF, Feldman HA, et al. (2012) Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 307, 26272634.
32Westman EC, Feinman RD, Mavropoulos JC, et al. (2007) Low-carbohydrate nutrition and metabolism. Am J Clin Nutr 86, 276284.
33Volek JS, Sharman MJ & Forsythe CE (2005) Modification of lipoproteins by very low-carbohydrate diets. J Nutr 135, 13391342.
34Krauss RM, Blanche PJ, Rawlings RS, et al. (2006) Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr 83, 10251031.
35Berneis KK & Krauss RM (2002) Metabolic origins and clinical significance of LDL heterogeneity. J Lipid Res 43, 13631379.
36Appel LJ, Sacks FM, Carey VJ, et al. (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the omniheart randomized trial. JAMA 294, 24552464.
37Anonymous (2001) Primer on statistical significance and P values. Eff Clin Pract 4, 183184.
38Wadden TA, Volger S, Sarwer DB, et al. (2011) A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 365, 19691979.
39Alberti KG, Zimmet P, Shaw J, et al. (2005) The metabolic syndrome – a new worldwide definition. Lancet 366, 10591062.
40Kass L, Weekes J & Carpenter L (2012) Effect of magnesium supplementation on blood pressure: a meta-analysis. Eur J Clin Nutr 66, 411418.
41Ried K, Sullivan TR, Fakler P, et al. (2012) Effect of cocoa on blood pressure. The Cochrane Database of Systematic Reviews, issue 8 CD008893.
42Haufe S, Engeli S, Kast P, et al. (2011) Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects. Hepatology 53, 15041514.
43Phillips SA, Jurva JW, Syed AQ, et al. (2008) Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity. Hypertension 51, 376382.
44Lagiou P, Sandin S, Lof M, et al. (2012) Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ 344, e4026e4037.
45Friedman AN, Ogden LG, Foster GD, et al. (2012) Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clin J Am Soc Nephrol 7, 11031111.
46Greenberg I, Stampfer MJ, Schwarzfuchs D, et al. (2009) Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT). J Am Coll Nutr 28, 159168.
47Institute of Medicine (2011) Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academy Press.
48Centre for Reviews and Dissemination (2009) Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care. York: York Publishing Services.
49Shai I, Schwarzfuchs D, Henkin Y, et al. (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359, 229241.
50Dansinger ML, Gleason JA, Griffith JL, et al. (2005) Comparison of the atkins, ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293, 4353.
51Davis NJ, Tomuta N, Schetcher C, et al. (2009) Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care 32, 11471152.
52Dyson PA, Beatty S & Matthews DR (2010) An assessment of low-carbohydrate or low-fat diets for weight loss at 2 year's follow-up. Diabet Med 27, 363368.
53Foster GD, Wyatt HR, Hill JO, et al. (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348, 20822090.
54Lim SS, Noakes M, Keogh JB, et al. (2010) Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control. Nutr Metab Cardiovasc Dis 20, 599607.
55McAuley KA, Smith KJ, Taylor RW, et al. (2006) Long-term effects of popular dietary approaches on weight loss and features of insulin resistance. Int J Obes (Lond) 30, 342349.
56Truby H, Baic S, deLooy A, et al. (2006) Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials”. BMJ 332, 13091314.
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