Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

The effects of low-fat, high-carbohydrate diets vs. low-carbohydrate, high-fat diets on weight, blood pressure, serum liquids and blood glucose: a systematic review and meta-analysis

Abstract

Our aim was to determine the relative effectiveness of two dietary macronutrient patterns (LFHC (low-fat, high-carbohydrate) diets and LCHF (low-carbohydrate, high-fat) diets) on weight loss and cardiovascular risk factors. We searched four databases including MEDLINE, EMBASE, Cochrane Library, and Web of Science to identify the eligible studies on March 13, 2020. Randomized clinical trials (RCT) were included which compared the effect of two diets (LFHC and LCHF) on weight loss, blood pressure, serum liquids, and blood glucose in overweight or obesity adults. Standardized mean difference (SMD) and 95% confidence interval (CI) were used for the pooled results. This paper included eleven studies involving 739 participants. Compared with LFHC diets, LCHF diets had a greater effect on weight loss (SMD = –1.01 kg; 95% CI –1.99 to –0.04, p = 0.04) and HDL-cholesterol changes (SMD = 0.82 mmol/l; 95% CI 0.43 to 1.21, p < 0.0001), but a smaller effect on total cholesterol decrease (SMD = 0.63 mmol/l; 95% CI 0.18–1.08, p = 0.006) and LDL-cholesterol decrease (SMD = 0.59 mmol/l; 95% CI 0.11–1.18, p = 0.05). Between the two groups, changes in lean mass, fat mass, systolic blood pressure, diastolic blood pressure, triglycerides, and glucose were non-significant. To conclude, both diets are effective for weight control and reduction of cardiovascular risk factors. And further studies with long-term follow-up are needed to confirm our results.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow diagram of the literature search process.
Fig. 2: Forest plots showing standardized mean differences (SMD) and 95% CI.

Similar content being viewed by others

References

  1. World Health Organization, 2020. Obesity and overweight, https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed on May 5, 2020].

  2. World Health Organization, 2020. Obesity, https://www.who.int/health-topics/obesity#tab=tab_1 [Accessed on May 5, 2020].

  3. Bradley U, Spence M, Courtney CH, McKinley MC, Ennis CN, McCance DR. et al. Low-fat versus low-carbohydrate weight reduction diets: effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial. Diabetes. 2009;58:2741–48.

    Article  CAS  Google Scholar 

  4. Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet. 2019;393:434–45.

    Article  CAS  Google Scholar 

  5. The Chinese Nutrition Society, 2016. The Food Guide Pagoda for Chinese Residents. Available from http://dg.cnsoc.org (Accessed on May 5, 2020) (in Chinese).

  6. García Gabarra A, Castellà Soley M, Calleja Fernández A. [Recommended energy and nutrients intakes in the European Union: 2008-2016]. Nutr Hosp. 2017;34:490–8.

  7. US Department of Agriculture, 2015. Dietary Guidelines for Americans 2015–2020, 8th Edition. http://health.gov/dietaryguidelines/2015/guidelines (Accessed on May 5, 2020).

  8. Smart NA, Marshall BJ, Daley M, Boulos E, Windus J, Baker N. et al. Low-fat diets for acquired hypercholesterolaemia. Cochrane Database Syst Rev. 2011;2:Cd007957

    Google Scholar 

  9. Seid H, Rosenbaum M. Low carbohydrate and low-fat diets: what we don’t know and why we should know It. Nutrients. 2019;11:2749.

  10. Hall KD. A review of the carbohydrate-insulin model of obesity. Eur J Clin Nutr. 2017;71:323–6.

    Article  CAS  Google Scholar 

  11. Bo S, Fadda M, Fedele D, Pellegrini M, Ghigo E, Pellegrini N. A critical review on the role of food and nutrition in the energy balance. Nutrients 2020;12:1161.

  12. Oh R, Uppaluri KR. Low Carbohydrate Diet. StatPearls. Treasure Island (FL); 2020.

  13. Ludwig DS, Friedman MI. Increasing adiposity consequence or cause of overeating?. JAMA. 2014;311:2167–8.

    Article  CAS  Google Scholar 

  14. Taubes G. The science of obesity: what do we really know about what makes us fat? An essay by Gary Taubes. BMJ. 2013;346:f1050.

    Article  Google Scholar 

  15. Swinburn BA. Long-term effects of a reduced fat diet intervention on cardiovascular disease risk factors in individuals with glucose intolerance. Diabetes Res Clin Pract. 2004;63:103–12.

    Article  Google Scholar 

  16. Astrup A. The role of dietary fat in the prevention and treatment of obesity. Efficacy and safety of low-fat diets. Int J Obes. 2001;25:S46–50.

    Article  CAS  Google Scholar 

  17. Apixaban Versus Warfarin in Patients With Left Ventricular Thrombus. NCT02982590. Published 2016. Accessed May 5, 2020.

  18. Clar C, Al-Khudairy L, Loveman E, Kelly SA, Hartley L, Flowers N. et al. Low glycaemic index diets for the prevention of cardiovascular disease. Cochrane Database Syst Rev. 2017;7:Cd004467

    PubMed  Google Scholar 

  19. Mansoor N, Vinknes KJ, Veierod MB, Retterstol K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br J Nutr. 2016;115:466–79.

    Article  CAS  Google Scholar 

  20. Sackner-Bernstein J, Kanter D, Kaul S. Dietary intervention for overweight and obese adults: comparison of low-carbohydrate and low-fat diets. a meta-analysis. PLoS ONE. 2015;10:e0139817

    Article  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. Hu T, Bazzano LA. The low-carbohydrate diet and cardiovascular risk factors: evidence from epidemiologic studies. Nutr Metab Cardiovasc Dis. 2014;24:337–43.

    Article  CAS  Google Scholar 

  23. Santos FL, Esteves SS, da Costa Pereira A, Yancy WS,Jr., Nunes JP. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev. 2012;13:1048–66.

    Article  CAS  Google Scholar 

  24. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9. w264.

    Article  Google Scholar 

  25. Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

  26. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:Ed000142.

    PubMed  Google Scholar 

  27. Kriston L. Dealing with clinical heterogeneity in meta-analysis. Assumptions, methods, interpretation. Int J Methods Psychiatr Res. 2013;22:1–15.

    Article  Google Scholar 

  28. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  CAS  Google Scholar 

  29. DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015;45:139–45.

    Article  Google Scholar 

  30. Aude YW, Agatston AS, Lopez-Jimenez F, Lieberman EH, Marie Almon N, Hansen M. et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial. Arch Intern Med. 2004;164:2141–6.

    Article  CAS  Google Scholar 

  31. Brinkworth GD, Noakes M, Buckley JD, Keogh JB, Clifton PM. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr. 2009;90:23–32.

    Article  CAS  Google Scholar 

  32. Fleming RM. The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors. Prev Cardiol. 2002;5:110-8.

  33. Hu T, Yao L, Reynolds K, Whelton PK, Niu T, Li S. et al. The effects of a low-carbohydrate diet vs. a low-fat diet on novel cardiovascular risk factors: a randomized controlled trial. Nutrients. 2015;7:7978–94.

    Article  CAS  Google Scholar 

  34. Meckling KA, O’Sullivan C, Saari D. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab. 2004;89:2717–23.

    Article  CAS  Google Scholar 

  35. Petrisko M, Kloss R, Bradley P, Birrenkott E, Spindler A, Clayton ZS, et al. Biochemical, anthropometric, and physiological responses to carbohydrate-restricted diets versus a low-fat diet in obese adults: a randomized crossover trial. J Med. Food 2020;23:206-14.

  36. Ruth MR, Port AM, Shah M, Bourland AC, Istfan NW, Nelson KP. et al. Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Metab: Clin Exp. 2013;62:1779–87.

    Article  CAS  Google Scholar 

  37. Tay J, Brinkworth GD, Noakes M, Keogh J, Clifton PM. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol. 2008;51:59–67.

    Article  CAS  Google Scholar 

  38. Utz W, Engeli S, Haufe S, Kast P, Böhnke J, Haas V. et al. Moderate dietary weight loss reduces myocardial steatosis in obese and overweight women. Int J Cardiol. 2013;167:905–9.

    Article  Google Scholar 

  39. Yancy WS,Jr, Westman EC, McDuffie JR, Grambow SC, Jeffreys AS, Bolton J. et al. A randomized trial of a low-carbohydrate diet vs orlistat plus a low-fat diet for weight loss. Arch Intern Med. 2010;170:136–45.

    Article  CAS  Google Scholar 

  40. Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. 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;110:1178–87.

    Article  CAS  Google Scholar 

  41. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS,Jr., Brehm BJ. et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:285–93.

    Article  CAS  Google Scholar 

  42. Brehm BJ, Seeley RJ, Daniels SR, D’Alessio DA. 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. J Clin Endocrinol Metab. 2003;88:1617–23.

    Article  CAS  Google Scholar 

  43. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the atkins, ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43–53.

    Article  CAS  Google Scholar 

  44. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS. et al. A randomized trial of a low-carbohydrate diet for obesity. N. Engl J Med. 2003;348:2082–90.

    Article  CAS  Google Scholar 

  45. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H. et al. ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37:2999–3058.

    Article  Google Scholar 

  46. 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;113:1640–61.

    Article  Google Scholar 

  47. Ge L, Sadeghirad B, Ball GDC, da Costa BR, Hitchcock CL, Svendrovski A, et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. Bmj. 2020;369:m696.

    Article  Google Scholar 

  48. Tipton KD. Efficacy and consequences of very-high-protein diets for athletes and exercisers. Proc Nutr Soc. 2011;70:205–14.

    Article  CAS  Google Scholar 

  49. Mettler S, Mitchell N, Tipton KD. Increased protein intake reduces lean body mass loss during weight loss in athletes. Med Sci Sports Exerc. 2010;42:326–37.

    Article  CAS  Google Scholar 

  50. Davey J, Turner RM, Clarke MJ, Higgins JP. Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis. BMC Med Res Methodol. 2011;11:160.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Wei Li or Yan Liang.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Q., Lang, X., Li, W. et al. The effects of low-fat, high-carbohydrate diets vs. low-carbohydrate, high-fat diets on weight, blood pressure, serum liquids and blood glucose: a systematic review and meta-analysis. Eur J Clin Nutr 76, 16–27 (2022). https://doi.org/10.1038/s41430-021-00927-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-021-00927-0

This article is cited by

Search

Quick links