Evidence mapPaperPMID 42418007Full record

ArticleEuropean journal of nutrition2026

Cardiometabolic trade-offs of carbohydrate- and fat-focused diets: a network meta-analysis of randomised clinical trials.

Katerina Nikitara, Meropi D Kontogianni, Anna-Bettina Haidich, Vasiliki Bountziouka

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In one paragraph

Article in European journal of nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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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.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Katerina NikitaraComputer Simulations, Genomics and Data Analysis Lab, Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Ierou Lochou 10 & Makrygianni, 81400, Lemnos, Greece.
Meropi D KontogianniDepartment of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 70 El. Venizelou St., 17676, Athens, Greece.
Anna-Bettina HaidichLaboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
Vasiliki BountzioukaComputer Simulations, Genomics and Data Analysis Lab, Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Ierou Lochou 10 & Makrygianni, 81400, Lemnos, Greece. vboun@aegean.gr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study compared the cardiometabolic effects of carbohydrate- and fat-focused dietary patterns in adults at increased cardiovascular disease (CVD) risk, with emphasis on trade-offs across lipid profiles, adiposity, blood pressure, and glycaemic outcomes.

methodsA systematic literature search (January 2013-October 2025) identified randomised clinical trials enrolling adults aged 35-75 years with at least one CVD risk factor and evaluating dietary interventions with explicit macronutrient targets. Diets were classified based on fat and carbohydrate distribution, with monounsaturated fat content considered a marker of dietary quality and the low-fat-moderate-carbohydrate diet serving as the reference category. A random-effects frequentist network meta-analysis was conducted to estimate mean differences (with 95% confidence intervals) in CVD markers between dietary patterns.

resultsForty-seven studies (n = 3,450) were included. High-fat-low-carbohydrate diets were associated with modest reductions in body mass index compared with low-fat-moderate-carbohydrate diets [- 0.48 kg/m (- 0.74; - 0.22)]. Ketogenic diets showed the largest increases in LDL cholesterol [0.43 mmol/L (0.13; 0.74)] total cholesterol [0.55 mmol/L (0.13; 0.96)] and HDL cholesterol [0.12 mmol/L (0.06; 0.18)], compared with the reference diet, whereas triglyceride responses differed, with high-carbohydrate diets increasing them [0.24 mmol/L (0.04; 0.43)]. Macronutrient composition had limited effects on waist circumference, blood pressure and glycaemic markers.

conclusionFindings demonstrate distinct cardiometabolic trade-offs between carbohydrate- and fat-focused dietary patterns, whereby carbohydrate restriction improves triglycerides, HDL cholesterol, and adiposity but is not consistently favourable for LDL cholesterol. These findings should be interpreted within the context of broad macronutrient targets rather than macronutrient quality and food-based dietary patterns. No single macronutrient distribution is universally optimal and dietary interventions should consider baseline metabolic profiles and macronutrient quality and quantity.

Indexed as

Cardiovascular DiseasesDietDietary CarbohydratesDietary FatsAdiposityAdultAgedBlood PressureBody Mass IndexDiet, Carbohydrate-RestrictedFemaleHumansLipidsMiddle AgedRandomized Controlled Trials as TopicTriglyceridesDietary CarbohydratesDietary FatsLipidsTriglyceridesAdiposityCardiovascular risk factorsDietary patternsLipid markersMacronutrient compositionNetwork meta-analysis

Identifiers

PMID42418007
PMCPMC13346310

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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.