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Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials

  • Nadia Mansoor (a1), Kathrine J. Vinknes (a1), Marit B. Veierød (a1) (a2) and Kjetil Retterstøl (a1) (a3)
Abstract
Abstract

The effects of low-carbohydrate (LC) diets on body weight and cardiovascular risk are unclear, and previous studies have found varying results. Our aim was to conduct a meta-analysis of randomised controlled trials (RCT), assessing the effects of LC diets v. low-fat (LF) diets on weight loss and risk factors of CVD. Studies were identified by searching MEDLINE, Embase and Cochrane Trials. Studies had to fulfil the following criteria: a RCT; the LC diet was defined in accordance with the Atkins diet, or carbohydrate intake of <20 % of total energy intake; twenty subjects or more per group; the subjects were previously healthy; and the dietary intervention had a duration of 6 months or longer. Results from individual studies were pooled as weighted mean difference (WMD) using a random effect model. In all, eleven RCT with 1369 participants met all the set eligibility criteria. Compared with participants on LF diets, participants on LC diets experienced a greater reduction in body weight (WMD –2·17 kg; 95 % CI –3·36, –0·99) and TAG (WMD –0·26 mmol/l; 95 % CI –0·37, –0·15), but a greater increase in HDL-cholesterol (WMD 0·14 mmol/l; 95 % CI 0·09, 0·19) and LDL-cholesterol (WMD 0·16 mmol/l; 95 % CI 0·003, 0·33). This meta-analysis demonstrates opposite change in two important cardiovascular risk factors on LC diets – greater weight loss and increased LDL-cholesterol. Our findings suggest that the beneficial changes of LC diets must be weighed against the possible detrimental effects of increased LDL-cholesterol.

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Corresponding author
* Corresponding author: N. Mansoor, fax +47 22851398, email n.mauland.mansoor@gmail.com
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Both authors contributed equally to this work.

Footnotes
References
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1. World Health Organization (2014) Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed August 2014).
2. Basen-Engquist K & Chang M (2011) Obesity and cancer risk: recent review and evidence. Curr Oncol Rep 13, 7176.
3. Ng M, Fleming T, Robinson M, et al. (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766781.
4. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114, 8296.
5. Law M (2000) Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach. Am J Clin Nutr 72, 1291S1296S.
6. Siri-Tarino PW, Sun Q, Hu FB, et al. (2010) Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atheroscler Rep 12, 384390.
7. Hu FB & Willett WC (2002) Optimal diets for prevention of coronary heart disease. JAMA 288, 25692578.
8. Astrup A (2001) The role of dietary fat in the prevention and treatment of obesity. Efficacy and safety of low-fat diets. Int J Obes Relat Metab Disord 25, Suppl. 1, S46S50.
9. Ley SJ, Metcalf PA, Scragg RK, et al. (2004) Long-term effects of a reduced fat diet intervention on cardiovascular disease risk factors in individuals with glucose intolerance. Diabetes Res Clin Pract 63, 103112.
10. Siri-Tarino PW, Sun Q, Hu FB, et al. (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 91, 535546.
11. Brehm BJ, Seeley RJ, Daniels SR, et al. (2003) A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 88, 16171623.
12. Bueno NB, de Melo IS, de Oliveira SL, et al. (2013) Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr 110, 11781187.
13. McAuley KA, Hopkins CM, Smith KJ, et al. (2005) Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Diabetologia 48, 816.
14. Tay J, Brinkworth GD, Noakes M, et al. (2008) Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol 51, 5967.
15. Nordmann 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 Inter Med 166, 285293.
16. Schwingshackl L & Hoffmann G (2013) Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet 113, 16401661.
17. Dattilo AM & Krisetherton PM (1992) Effects of weight-reduction on blood-lipids and lipoproteins – a metaanalysis. Am J Clin Nutr 56, 320328.
18. Berneis KK & Krauss RM (2002) Metabolic origins and clinical significance of LDL heterogeneity. J Lipid Res 43, 13631379.
19. Krauss RM & Siri PW (2004) Metabolic abnormalities: triglyceride and low-density lipoprotein. Endocrinol Metab Clin North Am 33, 405415.
20. Bravata DM, Sanders L, Huang J, et al. (2003) Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 289, 18371850.
21. Hu T, Mills KT, Yao L, et al. (2012) Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol 176, Suppl. 7, S44S54.
22. Atkins R (1992) Dr Atkins New Diet Revolution. New York: Avon Books.
23. Krauss RM, Eckel RH, Howard B, et al. (2000) AHA Dietary Guidelines: Revision 2000: a statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation 102, 22842299.
24. Moher D, Liberati A, Tetzlaff J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339, b2535.
25. Higgins JP & Greens S (2011) Assessing risk of bias in included studies. Cochrane Handbook of Systematic Reviews of Interventions Version 510. The Cochrane Collaboration. http://handbook.cochrane.org/chapter_8/8_assessing_risk_of_bias_in_included_studies.htm (accessed March 2015).
26. Furukawa TA, Barbui C, Cipriani A, et al. (2006) Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol 59, 710.
27. Shai I, Schwarzfuchs D, Henkin Y, et al. (2008) Efficacy and safety of low-carbohydrate, mediterranean, and low-fat diet strategies for weight loss-a two year dietary intervention randomized controlled trial (DIRECT). Diabetologia 51, S107S108.
28. Foster GD, Wyatt HR, Hill JO, et al. (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348, 20822090.
29. Morgan LM, Griffin BA, Millward DJ, et al. (2009) Comparison of the effects of four commercially available weight-loss programmes on lipid-based cardiovascular risk factors. Public Health Nutr 12, 799807.
30. Yancy WS, Jr, Olsen MK, Guyton JR, et al. (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 140, 769777.
31. DerSimonian R & Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7, 177188.
32. Higgins JP & Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21, 15391558.
33. Egger M, Davey Smith G, Schneider M, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.
34. Bazzano LA, Hu T, Reynolds K, et al. (2014) Effects of low-carbohydrate and low-fat diets: a randomized trial. Ann Intern Med 161, 309318.
35. Brinkworth 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.
36. Dansinger 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. JAMA 293, 4353.
37. Foster 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.
38. Gardner 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.
39. Lim 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.
40. Jacobs DR Jr, Mebane IL, Bangdiwala SI, et al. (1990) High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study. Am J Epidemiol 131, 3247.
41. Kingwell BA, Chapman MJ, Kontush A, et al. (2014) HDL-targeted therapies: progress, failures and future. Nat Rev Drug Discov 13, 445464.
42. Haase CL, Tybjaerg-Hansen A, Qayyum AA, et al. (2012) LCAT, HDL cholesterol and ischemic cardiovascular disease: a Mendelian randomization study of HDL cholesterol in 54500 individuals. J Clin Endocrinol Metab 97, E248E256.
43. Wu Z, Lou Y, Qiu X, et al. (2014) Association of cholesteryl ester transfer protein (CETP) gene polymorphism, high density lipoprotein cholesterol and risk of coronary artery disease: a meta-analysis using a Mendelian randomization approach. BMC Med Genet 15, 118.
44. Blackburn GL, Phillips JCC & Morreale S (2001) Physicians guide to popular low-carbohydrate weight-loss diets. Cleve Clin J Med 68, 761, 765–766, 768–769, 773–774.
45. Krauss RM & Dreon DM (1995) Low-density-lipoprotein subclasses and response to a low-fat diet in healthy men. Am J Clin Nutr 62, 478S487S.
46. Stern 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 Inter Med 140, 778785.
47. Higgins JPT & Green S (editors) (2011) Recommendations on testing for funnel plot asymmetry. Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 [updated March 2011]. http://handbook.cochrane.org/chapter_10/10_4_3_1_recommendations_on_testing_for_funnel_plot_asymmetry.htm (accessed February 2015).
48. Davey J, Turner RM, Clarke MJ, et al. (2011) Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis. BMC Med Res Methodol 11, 160.
49. Makris A & Foster GD (2011) Dietary approaches to the treatment of obesity. Psychiatr Clin North Am 34, 813827.
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