SynthesisThe American journal of clinical nutrition2025
Effects of carbohydrate-restricted diets and macronutrient replacements on cardiovascular health and body composition in adults: a meta-analysis of randomized trials.
Synthesis in The American journal of clinical nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed.
- Dietary Interventions for Hypertriglyceridemia.Current atherosclerosis reports · 2026Review
- Six- and Twelve-Month Changes in Body Composition and 24-h Energy Expenditure After a Very Low-Calorie Ketogenic Diet.Obesity (Silver Spring, Md.) · 2026Observational
- Ketogenic Diets and Low-Density Lipoprotein Cholesterol in Adults With Normal Weight: An Emerging Clinical Challenge.Journal of the American Heart Association · 2026Review
- Five-Year outcomes of a digitally delivered carbohydrate-reduced nutrition intervention for prediabetes: durability of diabetes prevention.Frontiers in nutrition · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCarbohydrate-restricted diets (CRDs) are widely promoted for improving cardiovascular and body composition outcomes, yet evidence remains mixed across dietary patterns, populations, and study designs.
objectivesThis meta-analysis evaluated the effects of CRDs on cardiovascular and anthropometric outcomes and examined whether these effects varied by diet type, macronutrient replacement, participant characteristics, and study features.
methodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, 174 randomized trials (n = 11,481) from 27 countries were included. Eligible studies compared CRDs (≤45% of energy from carbohydrates) to higher-carbohydrate diets in adults and reported cardiovascular or anthropometric outcomes. Random-effects models estimated standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup analyses explored differences by CRD type (ketogenic, low-carb, and moderate-carb), replacement macronutrient (fat, protein, or combination), sex, weight status, diabetes status, intervention delivery, caloric intakes, and study design. Metaregressions assessed the effects of intervention duration.
resultsCRDs significantly reduced triglycerides [SMD: -15.11 mg/dL; 95% CI: -18.76, -11.46], systolic (SMD: -2.05 mmHg; 95% CI: -3.13, -0.96) and diastolic blood pressure (SMD: -1.26 mmHg; 95% CI: -1.94, -0.57), various lipid profile ratios, and inflammatory markers (C-reactive protein, tumor necrosis factor-alpha), whereas increasing high-density lipoprotein (SMD: 2.92 mg/dL, 95% CI: 2.10, 3.74). Low-density lipoprotein (LDL) and total cholesterol increased modestly (SMD: 4.81, 95% CI: 2.58, 7.05; and SMD: 4.32 mg/dL, 95% CI: 1.66, 6.97, respectively). All measured body composition markers showed significant reductions. Moderate-carbohydrate diets offered balanced benefits, whereas ketogenic diets produced greater weight loss but greater increases in LDL and total cholesterol. Combined fat and protein replacements yielded the most comprehensive improvements. Benefits were most pronounced in females and individuals with overweight or obesity. Longer interventions amplified effects on lipid ratios and inflammatory markers.
conclusionsCRDs improved cardiovascular health and body composition, especially in diets with combined macronutrient replacement. Potential adverse effects, including LDL elevation and lean mass loss, warrant clinical monitoring. TRIAL REGISTRATION NUMBER: for body composition, PROSPERO: CRD420251043066 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043066); for cardiovascular health: CRD420251011748 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251011748).
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.