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Effectiveness of low-carbohydrate diets for long-term weight loss in obese individuals: a meta-analysis of randomized controlled trials
Abstract
Aim: To assess whether low‐carbohydrate (LC) diets are associated with differences in weight loss and well‐being in people with obesity, and their cardiovascular and renal safety. Materials and Methods: A meta‐analysis of randomized controlled trials longer than 3 months, retrieved through an extensive search on MedLine and Embase databases, comparing weight loss with LC and control diets in people with body mass index (BMI) greater than 30 kg/m 2 , was conducted. Results: We retrieved 25 trials. Compared with controls, LC diets were associated with significant reduction of body weight at 3‐4 (MD −2.59 [−3.93, −1.25] kg) and 6‐8 months (MD −2.64 [−4.32, −0.95]), but no difference at 10‐14 and 18‐30 months, and significantly greater BMI reduction at 3‐4 months (−1.66 [−2.70, −0.61] kg/m 2 ), but not at other time points. Because only four trials reported data on renal function and psychological variables, renal safety and impact on well‐being could not be assessed. Differences in fasting plasma glucose at any time point were not statistically significant. No significant differences in total or LDL cholesterol or blood pressure were found in the long term, whereas a long‐term reduction of triglycerides (23.26 [−45.53, −0.98] mg/dl at 18‐30 months), and increase of HDL cholesterol (MD 4.94 [0.30, 9.57] mg/dl at 18‐30 months), were observed. Conclusion: LC diets are associated with greater short‐term weight loss than non‐carbohydrate–restricted diets and a longer term favourable effect on cardiovascular risk factors. Further evidence on long‐term efficacy and renal safety is needed before LC diets can be recommended as the preferred diets in obese people.
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Several systematic reviews and meta-analyses over the past decade have unanimously shown that low-carbohydrate diets produce superior weight loss to low-fat diets, with mean differences ranging 1.01-2.64 kg.
“Several systematic reviews and meta-analyses over the past decade have examined the effects of LCDs, unanimously showing superior weight loss to LFDs [136,138–145], with mean differences ranging 1.01–2.64 kg.”
From International Society of Sports Nutrition position stand: diets for body weight reduction (2026) · cites this paper as [143]
The Results (Weight loss; page not provided) report greater weight loss with low-carbohydrate diets at 3–4 and 6–8 months, including a mean difference of 2.64 kg. But the comparison was with non-carbohydrate-restricted diets, not specifically low-fat diets, and the advantage was not significant at later time points. The copy does not establish unanimous findings across reviews or the lower end of the stated 1.01–2.64 kg range. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA systematic review and meta-analysis of 25 RCTs by Silverii et al. reported that, compared to control diets, low-carbohydrate diets statistically reduced body weight at 3-4 and 6-8 months, but the difference was no longer statistically significant at 10-14 and 18-30 months.
“In a systematic review and meta-analysis of 25 RCTs, Silverii et al. [143] reported that, compared to control diets, LCDs statistically reduced body weight at 3–4 and 6–8 months, but the difference was no longer statistically significant at 10–14 and 18–30 months.”
From International Society of Sports Nutrition position stand: diets for body weight reduction (2026) · cites this paper as [143]
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International Society of Sports Nutrition position stand: diets for body weight reduction
Aragon, A. A., Campbell, B. I., Schoenfeld, B. J., Stout, J. R., Kalman, D., Arciero, P. J., Arent, S. M., Kreider, R. B., Taylor, L. W., Bannock, L., et al. (2026) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2026.2740266
Metadata
- Authors
- Silverii, G. A., Cosentino, C., Santagiuliana, F., Rotella, F., Benvenuti, F., Mannucci, E., & Cresci, B.
- Affiliations
- Biomedical Sciences Department Florence University Florence
- Diabetology Unit Pistoia San Jacopo Hospital Pistoia Italy
- Diabetology Careggi Hospital Florence Italy
- Psychiatry Careggi Hospital Florence Italy
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2022-05-26
- Volume
- 24
- Issue
- 8
- Pages
- 1458-1468
- ISSN
- 1462-8902
- 1463-1326
- PMC
- PMC9546386
- Cited by
- 40
- References
- 17
- Language
- en
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