Carbohydrate-restricted diet types and macronutrient replacements for metabolic health in adults: A meta-analysis of randomized trials

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-09-13 DOI:10.1016/j.clnu.2025.09.005

Shuo Feng , Renming Liu , Brian Colwell , Sunghyun Chung , Adam Barry , Huishan Wang

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引用次数: 0

Abstract

Background and aims

Carbohydrate-restricted diets (CRDs) are increasingly used in managing metabolic disorders, yet evidence remains mixed regarding their effectiveness beyond glycemic control and across diverse populations. To systematically evaluate the effects of CRDs, ketogenic (KD), low-carbohydrate (LCD), and moderate-carbohydrate diets (MCD), and different macronutrient replacements (fat, protein, or both) on metabolic health-related biomarkers, including glycemic, hepatic, renal, adipokine, and lipid metabolism indices.

Methods

Five electronic databases, PubMed, MEDLINE, Embase, ERIC, and Web of Science, were used to identify relevant randomized trials. Outcomes analyzed included glucose, HbA1c, insulin, HOMA-IR, liver/kidney function markers, leptin, and beta-hydroxybutyrate (BHB). Subgroup analyses evaluated the effects of CRD type, macronutrient replacement, sex, diabetes status, weight status, study design (parallel vs. crossover), delivery mode (consultation vs. food provision), and calorie intakes (isocaloric vs. non-isocaloric).

Results

149 randomized controlled trials comprising 9104 adults across 28 countries were included. CRDs significantly improved glycemic control (including glucose: SMD = −2.94 mg/dL, 95 % CI: −4.19, −1.68; insulin: SMD = −8.19 pmol/L, 95 % CI: −11.04, −5.43; HOMA-IR = −0.54, 95 % CI: −0.75, −0.33), hepatic stress (GGT: SMD = −6.08 U/L, 95 % CI: −9.97, −2.20), renal function (UACR: SMD = −0.19, 95 % CI: −0.28, −0.10), and adipokine concentration (leptin: SMD = −3.25 ng/mL, 95 % CI: −4.91, −1.59), particularly in females, individuals with overweight/obesity, and people with T2DM. LCDs and MCDs showed the most consistent metabolic benefits. Combined fat and protein replacement yielded greater improvements. Isocaloric vs. non-isocaloric comparisons showed similar patterns, suggesting macronutrient composition alone may engender beneficial metabolic effects.

Conclusions

CRDs, particularly LCDs and MCDs with mixed macronutrient replacements, confer significant metabolic benefits independent of energy intake. These findings support CRDs as a potential nutritional strategy in metabolic disease prevention and management. Clinical supervision is recommended.

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碳水化合物限制饮食类型和大量营养素替代对成人代谢健康的影响：随机试验的荟萃分析

背景和目的碳水化合物限制饮食（CRDs）越来越多地用于治疗代谢紊乱，但其除血糖控制外的有效性以及在不同人群中的有效性证据仍不一致。系统评估CRDs、生酮饮食（KD）、低碳水化合物饮食（LCD）和中碳水化合物饮食（MCD）以及不同的宏量营养素替代品（脂肪、蛋白质或两者兼有）对代谢相关生物标志物的影响，包括血糖、肝脏、肾脏、脂肪因子和脂质代谢指标。方法采用PubMed、MEDLINE、Embase、ERIC、Web of Science 5个电子数据库对相关随机试验进行筛选。结果分析包括葡萄糖、HbA1c、胰岛素、HOMA-IR、肝肾功能标志物、瘦素和β -羟基丁酸（BHB）。亚组分析评估了CRD类型、宏量营养素替代、性别、糖尿病状况、体重状况、研究设计（平行vs交叉）、递送模式（咨询vs食物供应）和卡路里摄入量（等热量vs非等热量）的影响。结果纳入了149项随机对照试验，包括28个国家的9104名成年人。crd显著改善血糖控制(包括葡萄糖:SMD =−2.94 mg / dL, 95%置信区间CI:−4.19−1.68;胰岛素:SMD pmol / L =−8.19,95%置信区间CI:−11.04−5.43;HOMA-IR =−0.54,95%置信区间CI:−0.75−0.33),肝压力(GGT: SMD =−6.08 U / L, 95%置信区间CI:−9.97−2.20),肾功能(UACR: SMD =−0.19,95%置信区间CI:−0.28−0.10),和adipokine浓度(瘦素:SMD =−3.25 ng / mL, 95%置信区间CI:−4.91−1.59),特别是女性,超重/肥胖患者,患有2型糖尿病。lcd和mcd显示出最一致的代谢益处。脂肪和蛋白质的联合替代产生了更大的改善。等热量与非等热量的比较显示出相似的模式，表明单独的宏量营养素组成可能产生有益的代谢作用。结论scrd，特别是混合常量营养素替代的lcd和mcd，具有独立于能量摄入的显著代谢益处。这些发现支持CRDs作为代谢性疾病预防和管理的潜在营养策略。建议进行临床监督。

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.