Abstract
Background: The rise in obesity has emphasised a focus on lifestyle and dietary habits. We aimed to address the debate between low-carbohydrate and low-fat diets and compare their effects on body weight, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), total cholesterol, and triglycerides in an adult population. Method: Medline and Web of Science were searched for randomised controlled trials (RCTs) comparing low-fat and low-carbohydrate diets up to September 2019. Three independent reviewers extracted data. Risk of bias was assessed using the Cochrane tool. The meta-analysis was stratified by follow-up time using the random-effects models. Results: This meta-analysis of 38 studies assessed a total of 6499 adults. At 6–12 months, pooled analyses of mean differences of low-carbohydrate vs. low-fat diets favoured the low-carbohydrate diet for average weight change (mean difference −1.30 kg; 95% CI −2.02 to −0.57), HDL (0.05 mmol/L; 95% CI 0.03 to 0.08), and triglycerides (TG) (−0.10 mmol/L; −0.16 to −0.04), and favoured the low-fat diet for LDL (0.07 mmol/L; 95% CI 0.02 to 0.12) and total cholesterol (0.10 mmol/L; 95% CI 0.02 to 0.18). Conclusion and Relevance: This meta-analysis suggests that low-carbohydrate diets are effective at improving weight loss, HDL and TG lipid profiles. However, this must be balanced with potential consequences of raised LDL and total cholesterol in the long-term.
Highlights
Being overweight is associated with major long-term conditions including diabetes, cardiovascular disease (CVD), and several types of cancers, implicating the need to address obesity as a major risk factor for the most common chronic conditions [1,2,3]
Participants on low-carbohydrate diets experienced a greater significant increase in low-density lipoprotein cholesterol (LDL)-cholesterol and total cholesterol overall with results not being significant beyond 12 months, potentially due to lack of power
Our findings suggested that low-carbohydrate diets were more beneficial than low-fat diets for weight loss, high-density lipoprotein cholesterol (HDL), and triglycerides in the short-term
Summary
Being overweight is associated with major long-term conditions including diabetes, cardiovascular disease (CVD), and several types of cancers, implicating the need to address obesity as a major risk factor for the most common chronic conditions [1,2,3]. The growing prevalence of obesity, combined with diabetes estimates rising by 51% by 2045 [5] emphasise the need to undertake urgent action to reduce the burden of the obesity pandemic and the consequent rise in cardiovascular and associated diseases. We aimed to address the debate between low-carbohydrate and low-fat diets and compare their effects on body weight, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), total cholesterol, and triglycerides in an adult population. At 6–12 months, pooled analyses of mean differences of low-carbohydrate vs. low-fat diets favoured the low-carbohydrate diet for average weight change
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