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Grand Rounds

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

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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)

METHODS:

  • 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)

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

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

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Related ObG Topics:

Could Plant-Based Diets Help Prevent Type 2 Diabetes?
The DIETFITS Trial: Can Personal Genetics Determine Whether a Low-Fat or Low-Carb Diet is a Better Weight Loss Choice?
Cochrane Review: Do Low-Carb Diets Improve Weight-Loss for Overweight and Obese Adults?
Results of the DiRECT Trial: Can Weight Loss in a Primary Care Setting Achieve Remission of Type 2 Diabetes?

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