Aspects of diet, including macronutrient and food proﬁles, may affect visceral fat mass and metabolic syndrome.

Study Number: 20

Year: 2017

Study Design(COUNTRY 1=RCT 2= Systematic Review 3=Non-randomized controlled 4= single arm 5= post hoc analysis 6=Non-systematic review 7. Network meta-analysis 8=other 9 follow up to study): 1

Study background and AIM: "Aspects of diet, including macronutrient and food proﬁles, may affect visceral fat mass and metabolic syndrome. Previous studies exploring the effects of high-fat diets often include E-dense diets with large amounts of processed carbohydrates and poor overall quality, confounding effects of a high fat intake per se Aim: to test the hypothesis that consuming energy primarily from carbohydrate or fat in diets with similar food proﬁles would differentially affect the ability to reverse visceral adiposity and metabolic syndrome"

6 Months or longer: N

Number of subjects and analysis: 44

Low-carb diet arm: "Very high-fat, low-carb (VHFLC) Targets E: 8750kJ/d (~2090kcal/d) Carb: 10%E; 50g/d Protein: 17%E; 90g/d Fat: 73%E; 170g/d Reported intake: E: 8898kJ/d (~2127kcal/d) Carb: 56.1g/d; ~10.6%E Protein: 89.3g/d Fat: 167g/d; ~70.7%E"

Comparison diet ARM(S): "Low-fat high-carb (LCHF) Targets E: 8750kJ/d (~2090kcal/d) Carb: 53%E; 275g/d Protein: 17%E; 90g/d Fat: 30%E; 70g/d Reported intake: E: 9226kJ/d (~2205kcal/d) Carb: 281g/d; ~51.0%E Protein: 91.9g/d Fat: 71.9g/d; ~29.3%E"

Outcomes Studied: "Primary: visceral adiposity and metabolic syndrome markers Visceral adiposity and other measures of body composition, including: - weight - BMI - waist size - body fat %, body fat mass - subcutaneous fat Measure of metabolic syndrome: - SBP, DBP - lipids - glucose control (FBG, HbA1c) - inflammation (HOMA)"

Result Summary: "Both diets similarly improved (WG SS, BG NSS): - weight - waist size - abdominal subcutaneous fat mass - visceral fat mass - liver fat and liver function markers - TG - fasting insulin - insulin C-peptide - HbA1c - HOMA Diets differed (BG SS) for: - HDL-C - increased only in VHFLC diet - LDL-C, total-C - lowered only in LFHC diet Values reported are all unadjusted. WG SS p values NR."

FBG, Other Glucose Measures: "WG: N BG: N Favored LFHC diet At12 wks VHFLC diet -0.08mmol/L LFHC -0.0.33mmol/L BG SS p=0.013"

FBG WG Sign: 0

FBG BG Sign: 0

HbA1c: "WG: Y BG: N At12 wks VHFLC diet -0.52mmol/L LFHC -0.54mmol/L BG NSS "

HbA1c WG Sign: 1

HbA1c BG Sign: 0

Total C: "WG: NR BG: N Favored LFHC diet At 12 wks VHFLC diet +0.13mmol/L LFHC -0.96mmol/L BG SS p<0.001 "

Total C WG Sign: *

Total C BG: 0

HDL-C: "WG: Y BG: Y At 12 wks VHFLC diet +0.14mmol/L LFHC -0.01mmol/L BG SS p<0.001 "

HDL-C WG Sig: 1

HDL-C BG Sig: 1

LDL-C: "WG: N BG: N Favored LFHC diet At 12 wks VHFLC diet +0.26mmol/L LFHC -0.78mmol/L BG SS p<0.001"

LDL-C WG Sig: 0

LDL-C BG Sig: 0

TG: "WG: Y BG: N At 12 wks VHFLC diet -0.53mmol/L LFHC -0.41mmol/L BG NSS "

TG WG Sig: 1

TG BG Sig: 0

TG/HDL-C ratio WG Sig: *

TG/HDL-C ratio BG Sig: *

Weight/bmi, Body Composition: "Weight, body fat%, visceral fat mass, abdominal subcutaneous fat: all WG: Y BG: N At 12 wks Weight VHFLC diet: -10.4% LFHC: -10.9% WG SS both, BG NSS Visceral fat area VHFLC diet: -28.8% LFHC: -29.4% WG SS both, BG NSS "

Weight/BMI WG Sig: 1

Weight/BMI BG Sig: 0

SBP: "WG: Y BG: N At 12 wks VHFLC diet: -14mmHg LFHC: -15mmHg BG NSS "

SBP WG Sig: 1

SBP BG Sig: 0

DBP: "WG: Y BG: N At 12 wks VHFLC diet: -2.3mmHg LFHC -8mmHg: BG NSS "

DBP WG Sig: 1

DBP BG Sig: 0

Fasting Insulin: "WG: Y BG: N At 12 wks VHFLC diet: -5.70mU/L LFHC: -5.52mU/L BG NSS "

Fasting Insulin WG SS: 1

Fasting Insulin BG SS: 0

Insulin Sensitivity/Resistance: "HOMA2-IR & HOMA2-%S WG: Y BG: N HOMA2-IR At 12 wks VHFLC diet -0.48 LFHC -0.60BG NSS "

Insulin Receptor Improvement WG sig: 1

Insulin Receptor Improvement BG sig: 0

Inflammation: NR

CRP WG sig: *

CRP BG sig: *

Diabetes Medication Use: NA

Safety Adverse Events: "All liver function markers improved or NSS change. "

Retention and Compliance: Reported dietary intake suggests excellent adherence.

Study Author's Conclusions: " Our results are in line with systematic reviews and metaanalyses of epidemiologic and dietary intervention studies,which overall do not support a causal connection between SFA intake per se and risk of metabolic syndrome, fatty liver, or CVD, regardless of the effects on LDL cholesterol. ...Consuming E primarily as carbohydrate or fat for 3 mo did not differentially inﬂuence visceral fat and metabolic syndrome in a low-processed, lower-glycemic dietary context. Our data do not support the idea that dietary fat per se promotes ectopic [in abnormal place] adiposity and cardiometabolic syndrome in humans."

Abbreviations:

AHA - American Heart Association;

ALT - alanine aminotransferase;

AMDR - acceptable macronutrient distribution range;

AST - aspartate aminotransferase;

BG - between study groups;

BHOB - beta-hydroxybutyrate;

DBP - diastolic blood pressure;

E- energy, caloric intake;

eGFR - estimated glomerular filtration rate;

FBG - fasting blood glucose;

GGT - gamma-glutamyl transferase;

HDL-C - high-density lipoprotein cholesterol;

iGFR - isotope glomerurar filtration rate;

LDL-C - low-density lipoprotein cholesterol;

NAFLD - non-alcoholic fatty liver disease;

NR - not reported (or data needed for calculation not available);

N - no;

NA - not applicable;

NS - not specified;

NSS - not statistically significant;

SBP - systolic blood pressure;

SS - statistically significant;

TG - triglyceride;

total C - total cholesterol;

V - varied, mixed;

WG - within a study group;

WMD - weighted mean difference;

Y - yes

Number of People in Studies:

3,296 Enrolled in randomized controlled trials on 25% or less carbohydrates

2,626 Completed randomized controlled trials on 25% or less carbohydrates

79.67% 82% completion of studies

Duration of Trial

<6 Months

6-9 Months

1 -2 years

>2 years

Aspects of diet, including macronutrient and food proﬁles, may affect visceral fat mass and metabolic syndrome.

Abbreviations:

Number of People in Studies:

Duration of Trial

# of Trials

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