Low carbohydrate ketogenic diets reduce cardiovascular risk factor levels in obese or overweight patients with T2DM: A meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 36583214 · doi:10.3389/fnut.2022.1092031
What was done
Authors conducted a systematic review and meta-analysis searching PubMed, EMBASE, Web of Science, OVID, and Cochrane Library through September 2022. They included randomized controlled trials evaluating low-carbohydrate ketogenic diets versus non-ketogenic diets on cardiovascular risk factors (glycemia, anthropometrics, lipids) in overweight or obese patients. Continuous outcomes were pooled as weighted standardized mean differences (SMD), and subgroup analyses were performed based on baseline type 2 diabetes mellitus (T2DM) status. A total of 21 RCTs were included.
What was found
In patients with T2DM, low-carbohydrate ketogenic diets significantly outperformed non-ketogenic diets on: - Fasting plasma glucose: SMD -0.75 (P < 0.001) - HbA1c: SMD -0.53 (P < 0.001) - Body mass index: SMD -2.27 (P = 0.032) - Body weight: SMD -6.72 (P < 0.001) - Waist circumference: SMD -4.45 (P = 0.003) - Triglycerides: SMD -0.32 (P = 0.013) HDL changes in the T2DM group were reported as SMD -0.32 (P = 0.052). Across all patients regardless of diabetic status, ketogenic diets significantly decreased triglycerides (SMD -0.2, P = 0.02) and increased HDL (SMD 0.11, P = 0.03). Specific 95% confidence interval bounds were not provided in the abstract.
Why it matters
This review indicates that ketogenic diets yield greater improvements in glycemic control, adiposity, and triglycerides than non-ketogenic comparison diets in overweight or obese individuals with type 2 diabetes.
Limits
The abstract does not disclose the total participant count, intervention durations, comparator diet compositions, or 95% confidence intervals. Crucial cardiovascular markers such as LDL cholesterol, blood pressure, adherence rates, and long-term clinical endpoints were not reported in the abstract.