Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis

Ashtary-Larky, Damoon; Bagheri, Reza; Asbaghi, Omid; Tinsley, Grant M.; Kooti, Wesam; Abbasnezhad, Amir; Afrisham, Reza; Wong, Alexei

doi:10.1080/10408398.2021.1890689

Cited by 50Diet and metabolism studiesDietary Effects on HealthMuscle metabolism and nutrition

Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis

Ashtary-Larky, Damoon, Bagheri, Reza, Asbaghi, Omid, Tinsley, Grant M., Kooti, Wesam, Abbasnezhad, Amir, Afrisham, Reza, Wong, Alexei·2022·Critical Reviews in Food Science and Nutrition

DOI 10.1080/10408398.2021.1890689

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Abstract

We evaluated the effects of ketogenic diets (KDs) on body mass (BM), fat mass (FM), fat-free mass (FFM), body mass index (BMI), and body fat percentage (BFP) compared to non-KDs in individuals performing resistance training (RT). Online electronic databases including PubMed, the Cochrane Library, Web of Science, Embase, SCOPUS, and Ovid were searched to identify initial studies until February 2021. Data were pooled using both fixed and random-effects methods and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Out of 1372 studies, 13 randomized controlled trials (RCTs) that enrolled 244 volunteers were included. The pooled results demonstrated that KDs significantly decreased BM [(WMD = −3.67 kg; 95% CI: −4.44, −2.90, p < 0.001)], FM [(WMD = −2.21 kg; 95% CI: −3.09, −1.34, p < 0.001)], FFM [(WMD = −1.26 kg; 95% CI: −1.82, −0.70, p < 0.001)], BMI [(WMD = −1.37 kg.m−2; 95% CI: −2.14, −0.59, p = 0.022)], and BFP [(WMD = −2.27%; 95% CI: −3.63, −0.90, p = 0.001)] compared to non-KDs. We observed beneficial effects of KDs compared to non-KDs on BM and body fat (both FM and BFP) in individuals performing RT. However, adherence to KDs may have a negative effect on FFM, which is not ameliorated by the addition of RT.

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Seventeen meta-analyses were included.
“Seventeen meta-analyses were included (Fig. 1 and Additional file 2: Table S3) [1, 2, 15–17, 34–45].”
From Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials (2023) · cites this paper as [38]
In healthy participants, K-LCHF for 3-12 weeks reduced body weight by 3.68 kg (95% CI -4.45 to -2.90).
“In healthy participants, K-LCHF for 3–12 weeks could reduce body weight by 3.68 kg (95% CI, -4.45 to -2.90) but also significantly reduced muscle mass by 1.27 kg (95% CI, -1.83 to -0.70, MCID threshold 1.10 kg) [14, 26, 38].”
From Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials (2023) · cites this paper as [38]
In healthy participants, K-LCHF for 3-12 weeks significantly reduced muscle mass by 1.27 kg (95% CI -1.83 to -0.70, MCID 1.10 kg).
“In healthy participants, K-LCHF for 3–12 weeks could reduce body weight by 3.68 kg (95% CI, -4.45 to -2.90) but also significantly reduced muscle mass by 1.27 kg (95% CI, -1.83 to -0.70, MCID threshold 1.10 kg) [14, 26, 38].”
From Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials (2023) · cites this paper as [38]
A significant portion of the weight loss seen with ketogenic low-carbohydrate high-fat diet was due to muscle mass loss.
“On the other hand, a significant portion of the weight loss seen in K-LCHF was due to muscle mass loss [17, 38].”
From Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials (2023) · cites this paper as [38]

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Authors: Ashtary-Larky, D., Bagheri, R., Asbaghi, O., Tinsley, G. M., Kooti, W., Abbasnezhad, A., Afrisham, R., & Wong, A.
Affiliations: Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
University of Isfahan (IR)
Lorestan University of Medical Sciences (IR)
Texas Tech University (US)
Kurdistan University of Medical Sciences (IR)
Tehran University of Medical Sciences (IR)
Marymount University (US)
Corresponding author: Bagheri, Reza
Wong, Alexei
ORCID: Bagheri, Reza
Asbaghi, Omid
Tinsley, Grant M.
Kooti, Wesam
Abbasnezhad, Amir
Afrisham, Reza
Wong, Alexei
Venue: Critical Reviews in Food Science and Nutrition
Publisher: Informa UK Limited
Published: 2021-02-24
Volume: 62
Issue: 21
Pages: 5717-5732
ISSN: 1040-8398 (ISSN-L)
1549-7852
DOI: 10.1080/10408398.2021.1890689
OpenAlex: W3130269596
Semantic Scholar: 0bcb5e2281b1f2c95d3908b7c4214827aee20822
Cited by: 50
References: 105
Citations by year: 2026: 6 · 2025: 8 · 2024: 10 · 2023: 12 · 2022: 9 · 2021: 5
FWCI: 1.20
Type: journal article
Language: en
Open access: closed
Locations: Critical Reviews in Food Science and Nutrition (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Diet and metabolism studies
Health Sciences › Medicine › Physiology › Dietary Effects on Health
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
Keywords: ketogenic diet, resistance training, body composition, fat mass, fat-free mass, body mass index, body fat percentage, dietary adherence, weight loss
MeSH terms: Adipose Tissue, Body Composition, Humans, Body Mass Index, Resistance Training, Diet, Ketogenic

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Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis

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