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- Title
Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial.
- Authors
Hansen, Camilla Dalby; Gram-Kampmann, Eva-Marie; Hansen, Johanne Kragh; Hugger, Mie Balle; Madsen, Bjørn Stæhr; Jensen, Jane Møller; Olesen, Sara; Torp, Nikolaj; Rasmussen, Ditlev Nytoft; Kjærgaard, Maria; Johansen, Stine; Lindvig, Katrine Prier; Andersen, Peter; Thorhauge, Katrine Holtz; Brønd, Jan Christian; Hermann, Pernille; Beck-Nielsen, Henning; Detlefsen, Sönke; Hansen, Torben; Højlund, Kurt
- Abstract
Whether a low-carbohydrate, high-fat diet is a possible treatment strategy for type 2 diabetes is unclear. This trial examined whether a low-carbohydrate, high-fat diet without a recommendation to restrict calories is more effective than a high-carbohydrate, low-fat diet at improving glycemic control, metabolic markers, and nonalcoholic fatty liver disease. Visual Abstract. Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet.: Whether a low-carbohydrate, high-fat diet is a possible treatment strategy for type 2 diabetes is unclear. This trial examined whether a low-carbohydrate, high-fat diet without a recommendation to restrict calories is more effective than a high-carbohydrate, low-fat diet at improving glycemic control, metabolic markers, and nonalcoholic fatty liver disease. Background: It remains unclear if a low-carbohydrate, high-fat (LCHF) diet is a possible treatment strategy for type 2 diabetes mellitus (T2DM), and the effect on nonalcoholic fatty liver disease (NAFLD) has not been investigated. Objective: To investigate the effect of a calorie-unrestricted LCHF diet, with no intention of weight loss, on T2DM and NAFLD compared with a high-carbohydrate, low-fat (HCLF) diet. Design: 6-month randomized controlled trial with a 3-month follow-up. (ClinicalTrials.gov: NCT03068078) Setting: Odense University Hospital in Denmark from November 2016 until June 2020. Participants: 165 participants with T2DM. Intervention: Two calorie-unrestricted diets: LCHF diet with 50 to 60 energy percent (E%) fat, less than 20E% carbohydrates, and 25E% to 30E% proteins and HCLF diet with 50E% to 60E% carbohydrates, 20E% to 30E% fats, and 20E% to 25E% proteins. Measurements: Glycemic control, serum lipid levels, metabolic markers, and liver biopsies to assess NAFLD. Results: The mean age was 56 years (SD, 10), and 58% were women. Compared with the HCLF diet, participants on the LCHF diet had greater improvements in hemoglobin A 1c (mean difference in change, −6.1 mmol/mol [95% CI, −9.2 to −3.0 mmol/mol] or −0.59% [CI, −0.87% to −0.30%]) and lost more weight (mean difference in change, −3.8 kg [CI, −6.2 to −1.4 kg]). Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. Changes in low-density lipoprotein cholesterol were less favorable in the LCHF diet group than in the HCLF diet group (mean difference in change, 0.37 mmol/L [CI, 0.17 to 0.58 mmol/L] or 14.3 mg/dL [CI, 6.6 to 22.4 mg/dL]). No statistically significant between-group changes were detected in the assessment of NAFLD. Changes were not sustained at the 9-month follow-up. Limitation: Open-label trial, self-reported adherence, unintended weight loss, and lack of adjustment for multiple comparisons. Conclusion: Persons with T2DM on a 6-month, calorie-unrestricted, LCHF diet had greater clinically meaningful improvements in glycemic control and weight compared with those on an HCLF diet, but the changes were not sustained 3 months after intervention. Primary Funding Source: Novo Nordisk Foundation.
- Subjects
DENMARK; NON-alcoholic fatty liver disease; HIGH-fat diet; HIGH-carbohydrate diet; LOW-fat diet; TYPE 2 diabetes
- Publication
Annals of Internal Medicine, 2023, Vol 176, Issue 1, p10
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/M22-1787