The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis

Autoři: Tingting Dong aff001;  Man Guo aff002;  Peiyue Zhang aff001;  Guogang Sun aff001;  Bo Chen aff001
Působiště autorů: Human Anatomy Histology and Embryology, Southwest Medical University, Luzhou, PR China aff001;  Department of Diabetes and Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, PR China aff002
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225348



Low-carbohydrate diets are associated with cardiovascular risk factors; however, the results of different studies are inconsistent.


The aim of this meta-analysis was to assess the relationship between low-carbohydrate diets and cardiovascular risk factors.


Four electronic databases (PubMed, Embase, Medline, and the Cochrane Library) were searched from their inception to November 2018. We collected data from 12 randomized trials on low-carbohydrate diets including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and blood pressure levels, as well as weight as the endpoints. The average difference (MD) was used as the index to measure the effect of a low-carbohydrate diet on cardiovascular risk factors with a fixed-effects model or random-effects model. The analysis was further stratified by factors that might affect the results of the intervention.


From 1292 studies identified in the initial search results, 12 randomized studies were included in the final analysis, which showed that a low-carbohydrate diet was associated with a decrease in triglyceride levels of -0.15mmol/l (95% confidence interval -0.23 to -0.07). Low-carbohydrate diet interventions lasting less than 6 months were associated with a decrease of -0.23mmol/l (95% confidence interval -0.32 to -0.15), while those lasting 12–23 months were associated with a decrease of -0.17mmol/l (95% confidence interval -0.32 to -0.01). The change in the body weight in the observation groups was -1.58kg (95% confidence interval -1.58 to -0.75); with for less than 6 months of intervention,this change was -1.14 kg (95% confidence interval -1.65 to -0.63),and with for 6–11 months of intervention, this change was -1.73kg (95% confidence interval -2.7 to -0.76). The change in the systolic blood pressure of the observation group was -1.41mmHg (95% confidence interval—2.26 to -0.56); the change in diastolic blood pressure was -1.71mmHg (95% confidence interval—2.36 to -1.06); the change in plasma HDL-C levels was 0.1mmHg (95% confidence interval 0.08 to 0.12); and the change in serum total cholesterol was 0.13mmol/l (95% confidence interval 0.08 to 0.19). The plasma LDL-C level increased by 0.11mmol/l (95% confidence interval 0.02 to 0.19), and the fasting blood glucose level changed 0.03mmol/l (95% confidence interval -0.05 to 0.12),which was not significant.


This meta-analysis confirms that low-carbohydrate diets have a beneficial effect on cardiovascular risk factors but that the long-term effects on cardiovascular risk factors require further research.

Klíčová slova:

Blood pressure – Cardiovascular diseases – Diet – Diet and type 2 diabetes – Cholesterol – Lipoproteins – Medical risk factors – Metaanalysis


1. WHO.Cardiovascular diseases (CVDS). http://www.Who.Int/mediacentre/factsheets/fs317/en/.2013.

2. Chen Z. The third national retrospective sampling mortality survey report. Beijing: China Union Medical University Publishing House; 2008.

3. Appel LJ, Sacks FM, Carey VJ, et al. OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005; 294(19):2455–2464. doi: 10.1001/jama.294.19.2455 16287956

4. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999; 99(6):779–785. doi: 10.1161/01.cir.99.6.779 9989963

5. Estruch R, Ros E, Salas-Salvadó J, et al. PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368(14):1279–1290. doi: 10.1056/NEJMoa1200303 23432189

6. Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from fve continents (PURE): a prospective cohort study. Lancet 2017; 390: 2050–62. doi: 10.1016/S0140-6736(17)32252-3 28864332

7. Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, et al. Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies. 2008;87:627–37. doi: 10.1093/ajcn/87.3.627 18326601

8. Blaak EE, Antoine JM, Benton D, Bjorck I, Bozzetto L, Brouns F, et al. Impact of postprandial glycaemia on health and prevention of disease. Obesity Reviews 2012;13(10): 923–84. doi: 10.1111/j.1467-789X.2012.01011.x 22780564

9. Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One. 2014; 9: e100652. doi: 10.1371/journal.pone.0100652 25007189

10. Shai I, Schwarzfuchs D, Henkin Y, et al.Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med.2008;359: 229–41. doi: 10.1056/NEJMoa0708681 18635428

11. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, et al.A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med.2003;348: 2082–2090. doi: 10.1056/NEJMoa022207 12761365

12. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al.A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med.2003;348:2074–81. doi: 10.1056/NEJMoa022637 12761364

13. Santos FL, Esteves SS, da Costa Pereira A, et al.Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev.2012;13,1048–1066. doi: 10.1111/j.1467-789X.2012.01021.x 22905670

14. Lagiou P, Sandin S, Lof M, Trichopoulos D, Adami HO, et al.Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ.2012;344:e4026. doi: 10.1136/bmj.e4026 22735105

15. Gary D. Foster, Holly R. Wyatt, James O. Hill, et al.Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet.Ann Intern Med.2010;153:147–157. doi: 10.7326/0003-4819-153-3-201008030-00005 20679559

16. Morgan LM, Griffin BA, Millward DJ, DeLooy A,et al.Comparison of the effects of four commercially available weight-loss programmes on lipid-based cardiovascular risk factors. Public Health Nutr.2009;12(6):799–807. doi: 10.1017/S1368980008003236 18647427

17. Lydia A. Bazzano, Tian Hu, Kristi Reynolds,et al.Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial. Ann Intern Med.2014;161(5):309–318. doi: 10.7326/M14-0180 25178568

18. Lean MEJ, Han TS, Prvan T,et al.Weight loss with high and low carbohydrate 1200 kcal diets in free living women. European Journal of Clinical Nutrition.1997;51:243–248. doi: 10.1038/sj.ejcn.1600391 9104574

19. Frank M. Sacks, George A. Bray, Vincent J. Carey, et al.Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. N Engl J Med.2009;360:859–73. doi: 10.1056/NEJMoa0804748 19246357

20. Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker SA. low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab.2010;12(3):204‐209. doi: 10.1111/j.1463-1326.2009.01151.x 20151996

21. Tay J, Luscombe-Marsh ND, Thompson CH,et al.Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr.2015;102(4):780–790. doi: 10.3945/ajcn.115.112581 26224300

22. Gary D Foster, Holly R. Wyatt, James O. Hill, et al.A Randomized Trial of a Low-Carbohydrate Diet for Obesity. N Engl J Med.2003;348:2082–90. doi: 10.1056/NEJMoa022207 12761365

23. Bonnie J. Brehm, Randy J. Seeley, Stephen R. Danels.A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. Clinical Endocrinology & Metabolism.2003;88(4):1617–1623.

24. Tay J, Luscombe-Marsh ND, Thompson CH, Jonathan DB, Gary AW,et al.Effects of an energy-restricted low-carbohydrate,high unsaturated fat/low saturated fat diet versus a high-carbohydrate,low-fat diet in type 2 diabetes:A 2-year randomized clinical trial.Diabetes obes metab.2015;20:858–871.

25. Liu Xin, Zhang Geng, Ye Xingwang, Li Huaixing, Chen Xiafei, Tang Lixin, et al.Effects of a low-carbohydrate diet on weight loss and cardiometabolic profile in Chinese women: a randomised controlled feeding trial.British Journal of Nutrition.2013;110(8):1444‐1453. doi: 10.1017/S0007114513000640 23522432

26. Lim SS, Noakes M, Keogh JB, Clifton PM.Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control. Nutrition, Metabolism and Cardiovascular Diseases.2010;20(8):599–607.

27. Bueno NB, de Melo IS, de Oliveira SL, et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013;110:1178–1187. doi: 10.1017/S0007114513000548 23651522

28. Hu T, Mills KT, Yao L, et al. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. 2012;176(suppl 7):S44–S54.

29. Schwingshackl L, Hoffmann G. Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113:1640–1661. doi: 10.1016/j.jand.2013.07.010 24139973

30. Teuta Gjuladin-Hellon Ian G. Davies, Penson Peter, et al.Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis. Nutrition Reviews.2019; 77: 161–180. doi: 10.1093/nutrit/nuy049 30544168

31. Goldstein JL, Brown MS. A century of cholesterol and coronaries: from plaques to genes to statins. Cell. 2015;161:161–172. doi: 10.1016/j.cell.2015.01.036 25815993

32. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90, 056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267–1278. doi: 10.1016/S0140-6736(05)67394-1 16214597

33. Afilalo J, Majdan AA, Eisenberg MJ. Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials. Heart. 2007;93:914–921. doi: 10.1136/hrt.2006.112508 17277349

34. Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT.Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr.2006;83:1025–31. doi: 10.1093/ajcn/83.5.1025 16685042

35. Thongtang N, Diffenderfer MR, Ooi EMM, et al. Metabolism and proteomics of large and small dense LDL in combined hyperlipidemia: effects of rosuvastatin. J Lipid Res. 2017;58:1315–1324. doi: 10.1194/jlr.M073882 28392500

36. Meisinger C, Baumert J, Khuseyinova N, et al. Plasma oxidized low-density lipoprotein, a strong predictor for acute coronary heart disease events in apparently healthy, middle-aged men from the general population. Circulation. 2005;112:651–657. doi: 10.1161/CIRCULATIONAHA.104.529297 16043640

37. Krauss RM, Siri PW. Metabolic abnormalities: triglyceride and low-density lipoprotein. Endocrinol Metab Clin North Am. 2004;33:405–415. doi: 10.1016/j.ecl.2004.03.016 15158526

38. Hawken S, Ounpuu S,et a1.Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries(the INTERHEART study):case—control study[J].Lancet.2004;364:937–952. doi: 10.1016/S0140-6736(04)17018-9 15364185

39. Goff DC Jr, Bertoni, Kramer H, Bonds D, Blumenthal RS, Tsai MY, Psaty BM.Dyslipidemia prevalence, treatment, and control in the Multi. Ethnic Study of Atherosclerosis(MESA): gender, ethnicity, and coronary artery calcium[J]. Circulation.2006;113:647–656. doi: 10.1161/CIRCULATIONAHA.105.552737 16461837

40. Kris-Etherton PM, Etherton TD, Yu S.Efficacy of multiple dietary therapies in reducing cardiovascular disease risk factors. Am J Clin Nutr.1997;65:560–1. doi: 10.1093/ajcn/65.2.560 9022544

41. Third Report of the National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III)final report.Circulation.2002;106:3143–3421. 12485966

42. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB.The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol.2011;57:1299–1313. doi: 10.1016/j.jacc.2010.09.073 21392646

43. Rader DJ, Hovingh GK.HDL and cardiovascular disease.Lancet. 2014; 384(9943):618–625. doi: 10.1016/S0140-6736(14)61217-4 25131981

44. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health. Obes Res.1998;6(Suppl 2):51S–209S.

45. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al.A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med.2003;348:2074–81. doi: 10.1056/NEJMoa022637 12761364

46. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, et al.Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA.2007;297:969–77. doi: 10.1001/jama.297.9.969 17341711

47. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al.Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med.2008;359:229–41. doi: 10.1056/NEJMoa0708681 18635428

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