Grand Rounds

RCT Results: Low-Carb High-Fat Diet vs a High-Carb Low-Fat Diet for Type 2 Diabetes?

BACKGROUND AND PURPOSE:

Hansen et al. (Ann Intern Med, 2022) compared the effects of a low-carbohydrate, high-fat (LCHF) diet vs high-carbohydrate, low-fat (HCLF) diet on type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD)

6-month randomized controlled trial
- University hospital in Denmark
Participants
- T2D diagnosis
Interventions
- LCHF diet
  - 50 to 60 energy percent (E%) fat | <20E% carbohydrates | 25E% to 30E% proteins
- HCLF diet
  - 50E% to 60E% carbohydrates | 20E% to 30E% fats | 20E% to 25E% proteins
Study design
- Intervention lasted 6 months | Follow-up at 9 months
- Both dietary interventions were calorie unrestricted
Primary outcomes
- Glycemic control
- Serum lipid levels
- Metabolic markers
- Liver biopsies (to assess NAFLD)

165 participants
- Mean age: 56 (SD, 10) years; 58% women
After 6 months, participants on the LCHF diet
- Had greater improvements in hemoglobin A1c
  - Mean difference in change −6.1 mmol/mol (95% CI, −9.2 to −3.0)
- Lost more weight
  - Mean difference in change −3.8 kg (95% CI, −6.2 to −1.4)
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
- Mean difference in change 0.37 mmol/L (95% CI, 0.17 to 0.58)
There were no statistically significant between-group changes in NAFLD
Findings not sustained at the 9-month follow-up

After 6 months of intervention, participants in the LCHF diet group had improved glycemic control and achieved better weight loss than those in the HCLF diet group
However, these changes were not sustained 3 months after the dietary intervention was completed

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