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Low-carb diets no better than balanced-carbohydrate diets for reducing weight and cardiovascular risk
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Low-carb diets no better than balanced-carbohydrate diets for reducing weight and cardiovascular risk
How do low‐carbohydrate weight‐reducing diets (also known as low‐carb diets) compare with weight‐reducing diets that have balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults?
This systematic review failed to show that low‐carbohydrate weight‐reducing diets are superior to balanced‐carbohydrate weight‐reducing diets, with probably little or no difference in weight reduction and cardiovascular risk factors over the short (3 to 8.5 months) and long term (1 to 2 years).
The small pooled mean differences in weight reduction between the diets (about 1–2kg), while statistically significant in the short term, were not clinically important in the short or long term in overweight and obese adults without or with type 2 diabetes (low to moderate‐certainty evidence). These differences can at least in part be ascribed to biological weight fluctuations.
Most trials included participants without diagnosed cardiovascular disease or events at baseline, and average baseline low-density lipoprotein cholesterol levels and diastolic blood pressure across the trials were within the normal ranges defined for people without coronary artery disease. In people with lipid disorders and variability with atherogenic lipoprotein response, caution in recommending low‐carbohydrate and consequent high‐fat diets is warranted.
Evidence on participant‐reported adverse effects over 2 years was limited, and conclusions about these could not be drawn.
The interpretation of most weight-reduction trials is constrained by small samples, a lack of blinding and large loss to follow‐up, which were also observed across the trials in this review. None of the trials were judged as having low risk of bias overall. The overall risk of bias of outcomes across trials in participants without and with type 2 diabetes was predominantly high, largely due to high proportions of missing outcome data in many trials.
Debates on effective and safe diets for managing obesity in adults are ongoing. Low‐carbohydrate weight‐reducing diets continue to be widely promoted, marketed and commercialised as being more effective for weight loss and healthier than balanced‐carbohydrate weight‐reducing diets.
Naude CE, et al. Low‐carbohydrate versus balanced‐carbohydrate diets for reducing weight and cardiovascular risk. Cochrane Database Syst Rev 2022;1:CD013334. This review contains 61 trials with a total of 6925 participants.