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Cited by 14Diet and metabolism studiesDietary Effects on HealthNutritional Studies and Diet

Exploring the highs and lows of very low carbohydrate high fat diets on weight loss and diabetes‐ and cardiovascular disease‐related risk markers: A systematic review

Open access
Ross, Lynda J., Byrnes, Angela, Hay, Robin L., Cawte, Andrea, Musial, Jane E.·2021·Nutrition & Dietetics
DOI 10.1111/1747-0080.12649
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Abstract

Aim: Very low carbohydrate high fat diets (VLCHF) are increasingly popular for weight loss and diabetes management, but the risk implications of long‐term adherence to a high‐fat‐diet remain unclear, especially in high‐risk populations. This review aimed to examine adherence, weight loss, diabetes‐ and cardiovascular disease (CVD)‐related risk markers in adults consuming VLCHF diets. Methods: Online databases were searched for randomised controlled trials ≥3 months duration that met a pre‐defined macronutrient prescription: VLCHF ≤25%E carbohydrate, >35%E fat; low fat (LF) ≥45%E carbohydrate, ≤30%E fat; and reported energy, saturated fat (SFA), weight, blood glucose, cholesterol and blood pressure (BP). Studies were excluded if the macronutrient prescription was not targeted (n = 32); not met (n = 17) or not reported (n = 13). Results: Eight studies included: 1217 commenced; 922 completed overweight and obese adults. Diets were isocaloric moderately energy‐restricted, closely monitored with ongoing support from dietitians, physicians, and/or nurses. Four studies reported non‐adherence beyond 3 months (n = 3) and 6 months (n = 1) despite interventions of 12, 15 and 24 months. VLCHF diets were high in fat and SFA (fat 49%‐56%E; SFA 11%‐21%E) compared to LF diets (fat 13%‐29%E; SFA 5%‐11%E). All groups achieved significant weight loss and improvements in BP and blood glucose. LDL‐C reduction favoured LF, P < .05; increased HDL‐C and reduced triglyceride levels favoured VLCHF, P < .05. Conclusions: VLCHF and LF diets with moderate energy restriction demonstrate similar weight loss and improvements to BP to 3 months. However, adherence is likely poor without intensive support from health professionals. Dietary SFA should be monitored to ensure recommended intakes, but longer‐term studies with high adherence are required to confirm the level of CVD‐risk and potential harms.

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  • A recent review by Ross et al. reported that in the 8 studies reviewed, diabetes markers (fasting blood glucose, HbA1c, and insulin) were generally improved regardless of whether individuals were on a very-low-carbohydrate or low-fat diet.

    “Similarly, a recent review by Ross et al. reported that in the 8 studies reviewed, diabetes markers (fasting blood glucose, Hb1Ac, and insulin) were generally improved regardless if individuals were on a very-low-carbohydrate or low-fat diet [88].”

    From Benefits of low carbohydrate diets: a settled question or still controversial? (2021) · cites this paper as [88]

  • Differences between arms in the Ross et al. review were limited to two studies, one favoring the very-low-carbohydrate diet and the other favoring the low-fat diet.

    “Differences between arms were limited to two studies, one favoring the very-low-carbohydrate diet and the other favoring the low-fat diet.”

    From Benefits of low carbohydrate diets: a settled question or still controversial? (2021) · cites this paper as [88]

  • Long-term adherence is consistently reported as a limitation of low-carbohydrate and very-low-carbohydrate diets, particularly the latter.

    “Long-term adherence is consistently reported as a limitation of low-carbohydrate and very-low-carbohydrate diets, particularly in the latter [84, 88, 89, 94].”

    From Benefits of low carbohydrate diets: a settled question or still controversial? (2021) · cites this paper as [88]

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Authors
Ross, L. J., Byrnes, A., Hay, R. L., Cawte, A., & Musial, J. E.
Affiliations
  • Griffith University (AU)
  • Royal Brisbane and Women's Hospital (AU)
  • Queensland University of Technology (AU)
ORCID
Venue
Nutrition & Dietetics
Publisher
Wiley
Published
2020-12-06
Volume
78
Issue
1
Pages
41-56
ISSN
  • 1446-6368 (ISSN-L)
  • 1747-0080
DOI
10.1111/1747-0080.12649
OpenAlex
W3110658986
Cited by
14
References
58
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 4
FWCI
0.29
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrition & Dietetics (publishedVersion)
  • PubMed (publishedVersion)
  • Griffith Research Online (submittedVersion, other-oa)
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
weight loss, dietary adherence, saturated fat intake, blood pressure, blood glucose, LDL cholesterol, HDL cholesterol, triglycerides, cardiovascular risk, diabetes risk, caloric restriction, low-fat diet, obesity, overweight adults
MeSH terms
Cardiovascular Diseases, Diabetes Mellitus, Humans, Biomarkers, Weight Loss, Risk Assessment, Diet, Carbohydrate-Restricted, Diet, High-Fat

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