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Cited by 91Diet and metabolism studiesDietary Effects on HealthNutritional Studies and Diet

Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk

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Naude, Celeste E, Brand, Amanda, Schoonees, Anel, Nguyen, Kim A, Chaplin, Marty, Volmink, Jimmy·2022·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd013334.pub2PMC PMC8795871
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Abstract

BACKGROUND: Debates on effective and safe diets for managing obesity in adults are ongoing. Low-carbohydrate weight-reducing diets (also known as 'low-carb diets') continue to be widely promoted, marketed and commercialised as being more effective for weight loss, and healthier, than 'balanced'-carbohydrate weight-reducing diets. OBJECTIVES: To compare the effects of low-carbohydrate weight-reducing diets to weight-reducing diets with balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults without and with type 2 diabetes mellitus (T2DM). SEARCH METHODS: We searched MEDLINE (PubMed), Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 25 June 2021, and screened reference lists of included trials and relevant systematic reviews. Language or publication restrictions were not applied. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in adults (18 years+) who were overweight or living with obesity, without or with T2DM, and without or with cardiovascular conditions or risk factors. Trials had to compare low-carbohydrate weight-reducing diets to balanced-carbohydrate (45% to 65% of total energy (TE)) weight-reducing diets, have a weight-reducing phase of 2 weeks or longer and be explicitly implemented for the primary purpose of reducing weight, with or without advice to restrict energy intake. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts and full-text articles to determine eligibility; and independently extracted data, assessed risk of bias using RoB 2 and assessed the certainty of the evidence using GRADE. We stratified analyses by participants without and with T2DM, and by diets with weight-reducing phases only and those with weight-reducing phases followed by weight-maintenance phases. Primary outcomes were change in body weight (kg) and the number of participants per group with weight loss of at least 5%, assessed at short- (three months to < 12 months) and long-term (≥ 12 months) follow-up. MAIN RESULTS: = 0%, 106 participants, 2 RCTs, very low-certainty evidence). Evidence on participant-reported adverse effects was limited, and we could not draw any conclusions about these. AUTHORS' CONCLUSIONS: There is probably little to no difference in weight reduction and changes in cardiovascular risk factors up to two years' follow-up, when overweight and obese participants without and with T2DM are randomised to either low-carbohydrate or balanced-carbohydrate weight-reducing diets.

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  • The ketogenic diet is associated with significant weight loss and improvements in several metabolic parameters.

    “This diet has been associated with significant weight loss and improvements in several metabolic parameters”

    From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [215]

    The Results (Effects of interventions; page unavailable) report weight loss from baseline in low-carbohydrate diet groups, and the Methods include ketogenic diets within that category. But the review does not establish significant weight loss and improvements in several metabolic parameters specifically for ketogenic diets; its Authors’ conclusions report little or no difference in weight loss or cardiovascular risk factors versus balanced-carbohydrate diets. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Calorically restricted low-carbohydrate diets are effective for weight loss.

    “Calorically restricted low-carbohydrate diets have been shown to be effective for weight loss”

    From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [215]

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Authors
Naude, C. E., Brand, A., Schoonees, A., Nguyen, K. A., Chaplin, M., & Volmink, J.
Affiliations
  • Stellenbosch University (ZA)
  • Liverpool School of Tropical Medicine (GB)
Corresponding author
Naude, Celeste E
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2022-01-28
Volume
2022
Issue
1
Pages
CD013334-CD013334
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd013334.pub2
PMC
PMC8795871
OpenAlex
W4220926409
Cited by
91
References
45
Citations by year
2026: 9 · 2025: 20 · 2024: 21 · 2023: 25 · 2022: 15 · 2021: 1
FWCI
2.79
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • Deutsches Krebsforschungszentrum
  • Hairy Cell Leukemia Foundation
Topics
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
low-carbohydrate diet, weight loss, obesity, overweight, type 2 diabetes, cardiovascular risk, caloric restriction, adverse effects, dietary intervention, weight change, cardiovascular risk factors, dyslipidemia, blood pressure, blood glucose, insulin resistance, long-term weight maintenance, quality of life
MeSH terms
Heart Disease Risk Factors, Adult, Body Weight, Energy Intake, Carbohydrates, Female, Humans, Male, Diet, Carbohydrate-Restricted

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