Effect of carbohydrate restriction on body weight in overweight and obese adults: a systematic review and dose–response meta-analysis of 110 randomized controlled trials
Open accessAbstract
Introduction: Carbohydrate-restricted diets are one of the most effective dietary interventions for weight loss. However, the optimum carbohydrate intake for implementing the most effective weight-loss interventions is still being discussed. We aimed to determine the optimum carbohydrate intake for short- and long-term weight loss in adults with overweight and obesity. Methods: We searched PubMed, Scopus, Web of Science, and CENTRAL from inception to May 2021 for randomized controlled trials examining the effect of a carbohydrate-restricted diet (≤45% of energy intake) as compared to a control diet (carbohydrate intake >45% of energy intake) on body weight in adults with overweight/obesity. A random-effects dose–response meta-analysis was conducted to calculate the mean difference for each 10% decrease in carbohydrate intake at the 6-month follow-up (1 to 6 months), 12-month follow-up (6 to 12 months), and follow-up longer than 12 months. The shape of the dose-dependent effects was also evaluated. The certainty of the evidence was rated using the GRADE approach. The minimal clinically important difference (MCID) threshold was defined as 5% weight loss (equal to 4.39 kg). Results: A total of 110 trials were selected for the present meta-analysis. In the linear dose–response meta-analysis, each 10% decrease in carbohydrate intake reduced body weight by 0.64 kg (95% CI: −0.79 to −0.49; n = 101 trials with 4,135 participants, high-certainty evidence) at the 6-month follow-up and by 1.15 kg (95% CI: −1.61 to −0.69; 42 trials with 2,657 participants, moderate-certainty evidence) at the 12-month follow-up. Non-linear dose–response meta-analyses indicated a monotonic reduction in body weight with the decrease in carbohydrate intake, with the greatest reduction at 5% at the 6-month follow-up (mean difference 5%: −3.96 kg, 95% CI: −4.92 to −3.00) and 10% at the 12-month follow-up (mean difference 10%: −6.26 kg, 95% CI: −10.42 to −2.10). At follow-up longer than 12 months, dose–response analyses suggested a non-linear effect, wherein carbohydrate intakes higher than 40% and lower than 30% were not effective for weight loss. Discussion: Carbohydrate restriction is an effective dietary strategy for important weight loss in adults with overweight and obesity. At 6-month and 12-month follow-ups, body weight decreased proportionally, more than the MCID threshold, along with the decrease in carbohydrate intake. At follow-up longer than 12 months, there was a non-linear effect, with the greatest reduction at 30% carbohydrate intake. Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD42022315042.
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Low carbohydrate diets have shown efficacy in managing clinical outcomes in type 2 diabetes.
“Low carbohydrate diets (LCD) have shown efficacy in managing clinical outcomes in type 2 diabetes (T2D).”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [6]
The Introduction (page unavailable) reports a prior meta-analysis finding that greater carbohydrate restriction was associated with weight loss in patients with type 2 diabetes. This paper’s own Conclusion (page unavailable) finds weight-loss benefits in adults with overweight or obesity, but it does not establish efficacy across clinical outcomes in type 2 diabetes. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPrescription of a low carbohydrate diet for management of T2D assists with weight loss.
“Research evidence shows that the prescription of a low carbohydrate diet (LCD) for management of T2D improves glycaemic control, reduces the need for medications, assists with weight loss, and may improve blood lipid concentrations5–9.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [6]
The Conclusion reports clinically important weight loss with carbohydrate-restricted diets at 6 and 12 months. However, the review studied adults with overweight or obesity regardless of health status; it does not establish the weight-loss effect specifically for diets prescribed to manage T2D. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPrescription of a low carbohydrate diet for management of T2D improves glycaemic control.
“Research evidence shows that the prescription of a low carbohydrate diet (LCD) for management of T2D improves glycaemic control, reduces the need for medications, assists with weight loss, and may improve blood lipid concentrations5–9.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [6]
The Introduction discusses weight loss and mentions insulin sensitivity, but does not say that low-carbohydrate diets improve glycaemic control in people with T2D. The Discussion and Conclusion report weight-loss findings; a further search for glycaemic control, HbA1c, and blood glucose found no passage establishing the claimed outcome. Page numbers are unavailable in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredPrescription of a low carbohydrate diet for management of T2D reduces the need for medications.
“Research evidence shows that the prescription of a low carbohydrate diet (LCD) for management of T2D improves glycaemic control, reduces the need for medications, assists with weight loss, and may improve blood lipid concentrations5–9.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [6]
The Introduction and Conclusion report weight-loss effects of carbohydrate restriction, including a reference to patients with type 2 diabetes, but do not address medication use. Searches for reduced medication need, antidiabetic drugs, and insulin found no passage supporting that specific claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPrescription of a low carbohydrate diet for management of T2D may improve blood lipid concentrations.
“Research evidence shows that the prescription of a low carbohydrate diet (LCD) for management of T2D improves glycaemic control, reduces the need for medications, assists with weight loss, and may improve blood lipid concentrations5–9.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [6]
The Conclusion reports weight loss in overweight and obese adults, but not improved blood lipid concentrations in people managing type 2 diabetes. Searches for lipid concentrations, triglycerides, cholesterol, and diabetes found no passage making that claim; the Discussion instead notes a possible increase in blood cholesterol with some carbohydrate-restricted diets. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- [30]Soltani S Jayedi A Abdollahi S Meshkini F Ahmadi A Shab-Bidar S. (2021). Dose-dependent effect carbohydrate restriction on body weight in overweight and obese adults: a protocol for systematic review and dose-response meta-analysis of randomized controlled trials. Available at: https://wwwcrdyorkacuk/prospero/display_record php?ID=CRD42022315042. PMC10731359 38125726
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Impaired hepatic BMAL1–FGF21 signaling drives adverse metabolic outcomes of ketogenic diet
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- Authors
- Soltani, S., Jayedi, A., Abdollahi, S., Vasmehjani, A. A., Meshkini, F., & Shab-Bidar, S.
- Affiliations
- Shahid Sadoughi University of Medical Sciences and Health Services (IR)
- Semnan University of Medical Sciences (IR)
- North Khorasan University of Medical Sciences (IR)
- Venue
- Frontiers in Nutrition
- Publisher
- Frontiers Media SA
- Published
- 2023-12-06
- Volume
- 10
- Pages
- 1287987-1287987
- ISSN
- 2296-861X (ISSN-L)
- PMC
- PMC10731359
- OpenAlex
- W4389393034
- Cited by
- 32
- References
- 62
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 8 · 2023: 1
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Shahid Sadoughi University of Medical Sciences
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- carbohydrate restriction, low-carbohydrate diet, weight loss, obesity, overweight, body weight, dose-response relationship, carbohydrate intake, dietary intervention, nonlinear dose-response relationship, minimal clinically important difference, long-term weight maintenance, dietary fat intake, protein intake, dietary fiber intake, micronutrients, alcohol consumption, sleep duration, physical activity
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