Comparison of Effects of Long-Term Low-Fat vs High-Fat Diets on Blood Lipid Levels in Overweight or Obese Patients: A Systematic Review and Meta-Analysis
Abstract
Dietary fat plays an important role in the primary prevention of cardiovascular disease, but long-term (≥12 months) effects of different percentages of fat in the diet on blood lipid levels remain to be established. Our systematic review and meta-analysis focused on randomized controlled trials assessing the long-term effects of low-fat diets compared with diets with high amounts of fat on blood lipid levels. Relevant randomized controlled trials were identified searching MEDLINE, EMBASE, and the Cochrane Trial Register until March 2013. Thirty-two studies were included in the meta-analysis. Decreases in total cholesterol (weighted mean difference -4.55 mg/dL [-0.12 mmol/L], 95% CI -8.03 to -1.07; P=0.01) and low-density lipoprotein (LDL) cholesterol (weighted mean difference -3.11 mg/dL [-0.08 mmol/L], 95% CI -4.51 to -1.71; P<0.0001) were significantly more pronounced following low-fat diets, whereas rise in high-density lipoprotein (HDL) cholesterol (weighted mean difference 2.35 mg/dL [0.06 mmol/L], 95% CI 1.29 to 3.42; P<0.0001) and reduction in triglyceride levels (weighted mean difference -8.38 mg/dL [-0.095 mmol/L], 95% CI -13.50 to -3.25; P=0.001) were more distinct in the high-fat diet groups. Including only hypocaloric diets, the effects of low-fat vs high-fat diets on total cholesterol and LDL cholesterol levels were abolished. Meta-regression revealed that lower total cholesterol level was associated with lower intakes of saturated fat and higher intakes of polyunsaturated fat, and increases in HDL cholesterol levels were related to higher amounts of total fat largely derived from monounsaturated fat (of either plant or animal origin) in high-fat diets (composition of which was ~17% of total energy content in the form of monounsaturated fatty acids, ~8% of total energy content in the form of polyunsaturated fatty acids), whereas increases in triglyceride levels were associated with higher intakes of carbohydrates. In addition, lower LDL cholesterol level was marginally associated with lower saturated fat intake. The results of our meta-analysis do not allow for an unequivocal recommendation of either low-fat or high-fat diets in the primary prevention of cardiovascular disease.
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The significant weight loss and increase in LDL-cholesterol in the LC v. LF groups in the present meta-analysis are consistent with several other meta-analyses.
“The signi fi cant weight loss and increase in LDL-cholesterol in the LC v . LF groups in the present meta-analysis are consistent with several other meta-analyses (12,15,16)”
From Effects of low-carbohydrate diets<i>v</i>. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as [16]
A meta-analysis of RCTs revealed that lifestyle and weight-loss intervention including diet in overweight and obese adults with type 2 diabetes resulted in a reduction of TC, LDL-C, and TG as well as an increase in HDL-C level in the subjects that achieved a weight loss of >5% over 1 year.
“A meta-analysis of RCTs revealed that lifestyle and weight-loss intervention including diet in overweight and obese adults with type 2 diabetes resulted in a reduction of TC, LDL-C, and TG as well as an increase in HDL-C level in the subjects that achieved a weight loss of > 5% over 1 year375).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [375]
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- Authors
- Schwingshackl, L., & Hoffmann, G.
- Corresponding author
- Schwingshackl, Lukas
- Venue
- Journal of the Academy of Nutrition and Dietetics
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 113
- Issue
- 12
- Pages
- 1640-1661
- ISSN
- 2212-2672 (ISSN-L)
- OpenAlex
- W2062691095
- Cited by
- 218
- References
- 97
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 18 · 2023: 15 · 2022: 23 · 2021: 29 · 2020: 25 · 2019: 10 · 2018: 22 · 2017: 13 · 2016: 15 · 2015: 17 · 2014: 13
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Academy of Nutrition and Dietetics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- low-fat diet, high-fat diet, dietary fat, serum lipids, overweight, obesity, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, saturated fat, polyunsaturated fatty acids, monounsaturated fatty acids, hypocaloric diet, cardiovascular disease prevention, diet composition, carbohydrate intake, long-term dietary intervention, weight loss, dyslipidemia, type 2 diabetes
- MeSH terms
- Adult, Energy Intake, Cardiovascular Diseases, Cholesterol, Dietary Carbohydrates, Fatty Acids, Fatty Acids, Unsaturated, Female, Humans, Lipids, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Obesity, Time Factors, Triglycerides, Randomized Controlled Trials as Topic, MEDLINE, Diet, Fat-Restricted, Overweight, Diet, High-Fat
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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