Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Eligibility Criteria
2.3. Outcomes Evaluated
2.4. Data Extraction and Risk of Bias Assessment
2.5. Statistical Analysis
3. Results
3.1. Study Identification and Selection
3.2. Study Characteristics and Risk of Bias
3.3. Measures of Glycaemia
3.4. Body Composition
3.5. Blood Pressure
3.6. Lipids
3.7. Measures of Inflammation
3.8. Other Cardiovascular Risk Markers
3.9. Liver Function
3.10. Renal Function
3.11. Medication Changes
3.12. Adverse Events
3.13. GRADE Summary of Findings
4. Discussion
4.1. Key Findings
4.2. Comparison with Previous Studies
4.3. Explanations for Findings
4.4. Implications of Findings
4.5. Strengths and Limitations
5. Conclusions
6. Key Points
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author, Year of Publication | Country | Population | Baseline Year | Mean Age, years | Male % | Mean BMI, kg/m2 | Mean HbA1c, % | Diabetes Duration, years | Trial Duration, years | No. Randomized | No. In Intervention | No. In Comparator | Overall Risk of Bias * |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Samaha, 2003 [42] | USA | Obese with diabetes | 2001 | NR | NR | NR | NR | NR | 6.0 | 79 | 41 | 38 | High |
Daly, 2006 [32] | UK | Obese with poorly controlled T2DM | NR | 58.7 | 48.0 | 36.1 | 9.1 | NR | 3.0 | 102 | 51 | 51 | High |
Westman, 2008 [50] | USA | Obesity and T2DM | NR | 51.8 | 21.4 | 38.1 | NR | NR | 6.0 | 84 | 38 | 46 | High |
Shai, 2008 [47] | Israel | Obese with T2DM | 2005–2007 | NR | NR | NR | NR | NR | 24.0 | 31 | 19 | 12 | High |
Davis, 2009 [33] | USA | T2DM with BMI ≥ 25 kg/m2, and A1C between 6 and 11% | 2004–2006 | 53.5 | 21.9 | 36.0 | 7.5 | NR | 12.0 | 105 | 55 | 50 | High |
Iqbal, 2010 [36] | USA | Obese with T2DM | 2004–2008 | 60.0 | 89.6 | 37.5 | NR | NR | 24.0 | 144 | 70 | 74 | High |
Goldstein, 2011 [34] | Israel | Obese T2DM | 2001–2004 | 56.0 | 48.1 | 33.2 | 8.9 | 8.0 | 12.0 | 52 | 26 | 26 | High |
Khoo, 2011 [38] | Australia | Obese with T2DM | 2007–2008 | 59.7 | 35.3 | 4.5 | 2.0 | 31 | 12 | 19 | High | ||
Guldbrand, 2012 [35]; Jonasson, 2014 [37] | Sweden | Diagnosis of T2DM treated with diet with or without additional oral glucose-lowering medication, incretin-based therapy or insulin | 2008–2009 | 62.0 | 44.3 | 32.7 | 7.3 | 9.3 | 24.0 | 61 | 30 | 31 | High |
Tay, 2014 [48]; Tay 2015 [54] | Australia | Obese adults with T2DM; taking antiglycaemic medication | 2012–2013 | 58.0 | 57.4 | 34.6 | 7.3 | 8.0 | 12.0 | 115 | 58 | 57 | High |
Yamada, 2014 [51] | Japan | Poorly controlled T2DM | 2011–2012 | 63.3 | 50.0 | 25.8 | 7.7 | 9.2 | 6.0 | 24 | 12 | 12 | High |
Saslow, 2014 [43] | USA | Overweight or obese adults with T2DM or prediabetes | 2012 | 59.7 | 26.5 | 36.8 | 6.8 | 7.1 | 3.0 | 34 | 16 | 18 | High |
Sato, 2017 [45]; Sato 2017a [46] | Japan | T2DM with poor glycaemic control | 2013–2014 | 59.4 | 75.8 | 26.6 | 8.2 | 13.5 | 18.0 | 66 | 33 | 33 | High |
Saslow, 2017 [44] | USA | Overweight with T2DM | 2013 | 55.7 | 40.0 | 7.2 | 5.5 | 7.4 | 25 | 12 | 13 | High | |
Nishimori, 2018 [40] | Japan | T2DM and NFLD | NR | 49.5 | 64.0 | NR | NR | 3.0 | 28 | 14 | 14 | High | |
Zadeh, 2018 [30] | Iran | Obese and T2DM | NR | 48.2 | 34.1 | 7.0 | 6.5 | 6.0 | 22 | 11 | 11 | High | |
Tay, 2018 [49] | Australia | T2DM under the care of a GP/endocrinologist | 2012–2014 | 58.0 | 57.4 | 34.5 | 7.3 | 7.0 | 24.0 | 115 | 58 | 57 | High |
Perna, 2019 [41] | Italy | Obese and overweight with T2DM; only treated with metformin | NR | 67.0 | 35.3 | 31.4 | 6.0 | NR | 3.0 | 17 | 8 | 9 | High |
Chen, 2020 [31] | Taiwan | Poorly controlled T2DM | 2016 | 63.6 | 38.8 | NR | NR | 9.9 | 18.0 | 92 | 47 | 45 | High |
Morris, 2020 [39] | UK | T2D and BMI of at least 30 kg/m2 | 2018 | 67.0 | 45.0 | 35.4 | NR | 9.2 | 3.0 | 33 | 21 | 12 | High |
Gram-Kampmann, 2022 [53] | Denmark | T2DM with HbAIc > 48 mmol/mol | 2016–2018 | 56.6 | 43.7 | NR | NR | 5.1 | 0.5 | 71 | 49 | 22 | High |
Li, 2022 [52] | China | Overweight or obese with T2DM | 2018–2020 | 36.8 | NR | 29.4 | 8.7 | 0.3 | 0.25 | 60 | 30 | 30 | High |
Author, Year of Publication | Intervention | Description of Intervention | Comparator | Description of Comparator | Exercise Recommendations |
---|---|---|---|---|---|
Samaha, 2003 [42] | Low carb diet | 30 g/day or less | Low fat diet | Caloric restriction sufficient to create a deficit of 500 calories per day, with 30 percent or less of total calories derived from fat. | None recommended |
Daly, 2006 [32] | Low carb diet | 70 g/day | Low fat diet | Both groups | |
Westman, 2008 [50] | Low carb ketogenic diet | <20 g of carbohydrate daily | Low-glycemic, reduced-calorie diet | 500 kcal/day deficit from weight maintenance diet | Both groups |
Shai, 2008 [47] | Low-carb, non–restricted-calorie diet | 20 g/day for the 2 month induction phase | Low-fat, restricted-calorie diet | Energy intake of 1500 kcal per day for women and 1800 kcal per day for men, with 30% of calories from fat, 10% of calories from saturated fat, and an intake of 300 mg of cholesterol per day | Not specifically recommended |
Davis, 2009 [33] | Low carb diet | Initial 2-week phase of carbohydrate restriction of 20–25 g daily depending on baseline weight; increased intake at 5-g increments each week as participants lost weight | Low fat diet | Fat gram goal was 25% of energy needs, based on baseline weight; 53 energy percent | General recommendations made |
Iqbal, 2010 [36] | Low carb diet | <30 g/day | Low fat diet | ≤30% of calories from fat with a deficit of 500 kcal/day | Not specifically recommended |
Goldstein, 2011 [34] | Modified Atkins diet (very low carb diet) | Containing up to 25 g of carbs daily for the first 6 weeks after randomization, thereafter increasing to a ceiling of 40 g daily | Standard recommended ADA calorie-restricted diet | Containing 10−20% of the daily energy intake from protein and the other 80% divided between fats [which provided 18–20% of calories as MUFA, 8–10% as polyunsaturated fatty acids (PUFA) and 9–10% as SFA], carbohydrates and 35 g of fibre | Both groups |
Khoo, 2011 [38] | Low-fat, high-protein, reduced-carb diet | Reduction in daily energy intake by ~600 kcal | Low-calorie diet | 1000 kcal/day | Not specifically recommended |
Guldbrand, 2012 [35]; Jonasson, 2014 [37] | Low carb diet | 20 energy percent from carb | Low fat diet | 55–60 energy percent | Not specifically recommended |
Tay, 2014 [48]; Tay 2015 [54] | Low-carbohydrate, high unsaturated/low saturated fat diet | 14% carbohydrate [<50 g/day], 28% protein, and 58% fat [<10% saturated fat] plus structured exercise | High unrefined carbohydrate, low fat diet | 53% carbohydrate, 17% protein, and 30% fat [<10% saturated fat] plus structured exercise | Both groups |
Yamada, 2014 [51] | Low carb diet | <130 g/day | Calorie restricted diet | Carbohydrates = 50–60%, protein = 1.0–1.2 g/kg (<20%) and fat = <25% | Not reported |
Saslow, 2014 [43] | Low carb ketogenic diet | Reduce carbohydrate intake over 7–10 days to between 20–50 g of carbohydrates a day with the goal of achieving nutritional ketosis | Moderate carb, calorie-restricted diet | 45% to 50% of calories derived from carbohydrates | Both groups |
Sato, 2017 [45]; Sato 2017a [46] | Low carb diet | 130 g/day | Calorie restricted diet | The percentage of carbohydrate per total calorie was 50–60%, and that of proteinwas 1.0–1.2 g/kg | |
Saslow, 2017 [44] | Very low-carb ketogenic diet with lifestyle factors; “intervention” | Reduce carb intake to between 20–50 g of nonfiber carbohydrates a day | Online diet program based around a plate method diet | A low-fat diet that emphasizes green vegetables, lean protein sources, and somewhat limited starchy and sweet foods | Intervention group received exercise recommendations |
Nishimori, 2018 [40] | Low carb diet | 70–130 g/day | Calorie restricted diet | 25 kcal/kg of ideal body weight per day | Not reported |
Zadeh, 2018 [30] | Low carb diet plus high intensity interval training | 45% energy (E %) from fat, 20 E% from carbohydrate and 35 E% from protein | Low fat diet plus high intensity interval training | 30 E% from fat (less than 10 E% from saturated fat), 50 E% from carbohydrate and 20 E% from protein | Both groups |
Tay, 2018 [49] | Low-carb, high-unsaturated/low-saturated fat diet | 14% energy as carb, 28% as protein, 58% as fat (<10% saturated fat) | High-carbohydrate, low-fat diet | 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat) | Both groups |
Perna, 2019 [41] | Low carb diet and metformin | CHO <125 g/ day, 1600 kcal/day for females and 1800 kcal/day for males | Balanced standard diet | Carbohydrates 55–60%, lipids 25–30%, proteins 15–20% | Not reported |
Chen, 2020 [31] | Low carb diet | 90 g/day | Traditional diabetic diet | Macronutrient percentage was 50–60% for CHO, 1.0–1.2 g/kg for protein and ≤30% for fat | Both groups |
Morris, 2020 [39] | Low-energy, low-carb diet | 800–1000 kcal/day, with <26% of daily energy intake from carb and a minimum of 60 g protein/day | Usual care dietary advice | Healthy balanced eating | Not reported |
Gram-Kampmann, 2022 [53] | Low carb diet | Maximum of 20 E% of carbohydrates (mainly complex and water-soluble), 50–60 E% fat, and 25–30 E% protein. | Control diet | 50–60 E% carbohydrates mainly from fruit, vegetables, and whole-grain sources, 20–30 E% fat | Both groups |
Li, 2022 [52] | Ketogenic diet | carbohydrate 30–50 g, protein 60 g, fat 130 g, and total calories (1500 ± 50) Kcal | Routine diet for diabetes | Carbohydrate 250–280 g, protein 60 g, fat 20 g, total calories (1500 ± 50) Kcal | Not reported |
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Apekey, T.A.; Maynard, M.J.; Kittana, M.; Kunutsor, S.K. Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2022, 14, 4391. https://doi.org/10.3390/nu14204391
Apekey TA, Maynard MJ, Kittana M, Kunutsor SK. Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2022; 14(20):4391. https://doi.org/10.3390/nu14204391
Chicago/Turabian StyleApekey, Tanefa A., Maria J. Maynard, Monia Kittana, and Setor K. Kunutsor. 2022. "Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials" Nutrients 14, no. 20: 4391. https://doi.org/10.3390/nu14204391