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Cited by 561Diet and metabolism studiesDietary Effects on HealthDiabetes Management and Research

Efficacy and Safety of Low-Carbohydrate Diets: A Systematic Review

Bravata, Dena M., Sanders, Lisa, Huang, Jane, Krumholz, Harlan M., Olkin, Ingram, Gardner, Christopher D., Bravata, Dawn M.·2003·JAMA
DOI 10.1001/jama.289.14.1837
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Abstract

Context: Low-carbohydrate diets have been popularized without detailed evidence of their efficacy or safety. The literature has no clear consensus as to what amount of carbohydrates per day constitutes a low-carbohydrate diet. Objective: To evaluate changes in weight, serum lipids, fasting serum glucose, and fasting serum insulin levels, and blood pressure among adults using low-carbohydrate diets in the outpatient setting. Data Sources: We performed MEDLINE and bibliographic searches for English-language studies published between January 1, 1966, and February 15, 2003, with key words such as low carbohydrate, ketogenic, and diet. Study Selection: We included articles describing adult, outpatient recipients of low-carbohydrate diets of 4 days or more in duration and 500 kcal/d or more, and which reported both carbohydrate content and total calories consumed. Literature searches identified 2609 potentially relevant articles of low-carbohydrate diets. We included 107 articles describing 94 dietary interventions reporting data for 3268 participants; 663 participants received diets of 60 g/d or less of carbohydrates—of whom only 71 received 20 g/d or less of carbohydrates. Study variables (eg, number of participants, design of dietary evaluation), participant variables (eg, age, sex, baseline weight, fasting serum glucose level), diet variables (eg, carbohydrate content, caloric content, duration) were abstracted from each study. Data Extraction: Two authors independently reviewed articles meeting inclusion criteria and abstracted data onto pretested abstraction forms. Data Synthesis: The included studies were highly heterogeneous with respect to design, carbohydrate content (range, 0-901 g/d), total caloric content (range, 525-4629 kcal/d), diet duration (range, 4-365 days), and participant characteristics (eg, baseline weight range, 57-217 kg). No study evaluated diets of 60 g/d or less of carbohydrates in participants with a mean age older than 53.1 years. Only 5 studies (nonrandomized and no comparison groups) evaluated these diets for more than 90 days. Among obese patients, weight loss was associated with longer diet duration (P = .002), restriction of calorie intake (P = .03), but not with reduced carbohydrate content (P = .90). Low-carbohydrate diets had no significant adverse effect on serum lipid, fasting serum glucose, and fasting serum insulin levels, or blood pressure. Conclusions: There is insufficient evidence to make recommendations for or against the use of low-carbohydrate diets, particularly among participants older than age 50 years, for use longer than 90 days, or for diets of 20 g/d or less of carbohydrates. Among the published studies, participant weight loss while using low-carbohydrate diets was principally associated with decreased caloric intake and increased diet duration but not with reduced carbohydrate content.

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  • In a review of 94 trials on the efficacy of low-carbohydrate diets from 1966 to 2003, weight loss was principally associated with reduced energy intake and not reduced carbohydrate intake.

    “In a review of 94 trials on the efficacy of low-carbohydrate diets from 1966 to 2003, Bravata and colleagues 57 reported that weight loss was principally associated with reduced energy intake and not reduced carbohydrate intake.”

    From Diet in the management of weight loss (2006) · cites this paper as [57]

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Authors
Bravata, D. M., Sanders, L., Huang, J., Krumholz, H. M., Olkin, I., Gardner, C. D., & Bravata, D. M.
Affiliations
Stanford Medicine (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-04-09
Volume
289
Issue
14
Pages
1837
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.289.14.1837
OpenAlex
W2100023355
Cited by
561
References
115
Citations by year
2026: 4 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 13 · 2021: 18 · 2020: 17 · 2019: 11 · 2018: 17 · 2017: 8 · 2016: 16 · 2015: 23 · 2014: 24 · 2013: 21 · 2012: 26
FWCI
6.95
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
low-carbohydrate diet, ketogenic diet, weight loss, obesity, serum lipids, fasting serum glucose, fasting insulin, blood pressure, caloric restriction
MeSH terms
Blood Glucose, Blood Pressure, Diet, Reducing, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Humans, Insulin, Lipids, Obesity, Weight Loss, Body Mass Index, Caloric Restriction

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