Diabetes Metab J > Volume 46(3); 2022 > Article |
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CONFLICTS OF INTEREST
Seung-Hyun Ko has been executive editor of the Diabetes & Metabolism Journal since 2022. She was not involved in the review process of this review. Otherwise, there was no conflict of interest.
AUTHOR CONTRIBUTIONS
Conception or design: S.H.K., S.C., J.H.K., K.H.S., G.E.N., K.I.K.
Acquisition, analysis, or interpretation of data: J.H.C., Y.J.C., H.J.K., S.H.K., S.C., J.H.K., K.K.K., E.M.K., H.J.K., K.H.S., G.E.N.
Drafting the work or revising: J.H.C., Y.J.C., H.J.K., G.E.N.
Final approval of the manuscript: J.H.C., Y.J.C., H.J.K., S.H.K., S.C., J.H.K., K.K.K., E.M.K., H.J.K., K.H.S., G.E.N., K.I.K.
Outcome |
Illustrative comparative riska (95% CI) |
No. of participants | Quality of the evidence (GRADE) | |||
---|---|---|---|---|---|---|
Assumed risk (control) |
Corresponding risk |
|||||
Intervention | Mean difference | |||||
mLCDb | ||||||
Body weight, kg (follow-up: 8-24 weeks) | -3.74 | -4.77 | -1.03 (-1.68 to -0.39) | 3,660 (24 studies) | Low | |
Body mass index, kg/m2 (follow-up: 8-24 weeks) | -1.5 | -1.73 | -0.23 (-0.46 to 0.00) | 2,750 (15 studies) | Very low | |
Waist circumference, cm (follow-up: 12-24 weeks) | -4.83 | -5.48 | -0.65 (-1.16 to -0.14) | 2,340 (15 studies) | Moderate | |
Fat mass, kg (follow-up: 12-24 weeks) | -2.92 | -3.36 | -0.44 (-0.83 to -0.04) | 2,080 (14 studies) | Moderate | |
Fat-free mass, kg (follow-up: 12-24 weeks) | 0.17 | 0.00 | -0.17 (-0.49 to 0.14) | 1,139 (10 studies) | Low | |
Fat mass, % (follow-up: 12-24 weeks) | -2.7 | -2.61 | 0.09 (-0.45 to 0.64) | 445 (4 studies) | Low | |
Systolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -4.0 | -4.56 | -0.56 (-1.69 to 0.56) | 2,612 (19 studies) | Low | |
Diastolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -2.5 | -3.19 | -0.69 (-1.39 to 0.01) | 2,615 (19 studies) | Low | |
Triglyceride, mg/dL (follow-up: 8-24 weeks) | -11.8 | -25.56 | -13.76 (-19.78 to -7.74) | 2,896 (24 studies) | Low | |
LDL-C, mg/dL (follow-up: 12-24 weeks) | -4.6 | -2.31 | 2.29 (-0.41 to 4.99) | 2,721 (21 studies) | Very low | |
HDL-C, mg/dL (follow-up: 8-24 weeks) | -0.8 | 1.81 | 2.61 (1.34 to 3.89) | 2,448 (20 studies) | Moderate | |
HbA1c, % (follow-up: 8-24 weeks) | -0.2 | -0.40 | -0.20 (-0.39 to -0.01) | 739 (8 studies) | Low | |
Fasting insulin, μU/mL (follow-up: 12-24 weeks) | -0.9 | -1.84 | -0.94 (-1.73 to -0.16) | 1,855 (13 studies) | Moderate | |
Fasting glucose, mg/dL (follow-up: 8-24 weeks) | -3.1 | -3.42 | -0.32 (-1.23 to 0.58) | 2,143 (17 studies) | Low | |
C-reactive protein, mg/L (follow-up: 8-24 weeks) | -0.1 | -0.44 | -0.34 (-0.67 to -0.01) | 1,391 (11 studies) | Low | |
Adiponectin, μg/mL (follow-up: 8-24 weeks) | 0.2 | 0.65 | 0.45 (0.15 to 0.76) | 1,356 (8 studies) | Moderate | |
VLCDc | ||||||
Body weight, kg (follow-up: 8-24 weeks) | -3.75 | -7.42 | -3.67 (-4.84 to -2.51) | 1,266 (14 studies) | Moderate | |
Body mass index, kg/m2 (follow-up: 8-24 weeks) | -1.0 | -2.88 | -1.88 (-3.11 to -0.65) | 388 (5 studies) | Moderate | |
Waist circumference, cm (follow-up: 8-24 weeks) | -4.7 | -8.81 | -4.11 (-8.70 to 0.49) | 233 (2 studies) | Low | |
Fat mass, kg (follow-up: 8-24 weeks) | -4.8 | -7.81 | -3.01 (-6.29 to 0.27) | 168 (3 studies) | Low | |
Fat-free mass, kg (follow-up: 8-24 weeks) | -0.3 | -1.35 | -1.05 (-1.75 to -0.35) | 168 (3 studies) | Low | |
Fat mass, % (follow-up: 8-24 weeks) | -1.45 | -3.33 | -1.88 (-2.87 to -0.89) | 515 (4 studies) | Moderate | |
Systolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -3.0 | -4.97 | -1.97 (-3.68 to -0.25) | 506 (9 studies) | Moderate | |
Diastolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -2.1 | -2.78 | -0.68 (-1.79 to 0.44) | 906 (9 studies) | Low | |
Triglyceride, mg/dL (follow-up: 8-24 weeks) | -11.9 | -33.23 | -21.33 (-30.46 to -12.21) | 1,059 (13 studies) | Low | |
LDL-C, mg/dL (follow-up: 8-24 weeks) | -5.1 | 2.42 | 7.52 (3.34 to 11.70) | 1,023 (12 studies) | Moderate | |
HDL-C, mg/dL (follow-up: 8-24 weeks) | 0.0 | 4.30 | 4.30 (1.79 to 6.82) | 1,058 (13 studies) | Low | |
HbA1c, % (follow-up: 8-24 weeks) | -0.15 | -0.42 | -0.27 (-0.50 to -0.03) | 354 (6 studies) | Low | |
Fasting insulin, μU/mL (follow-up: 8-24 weeks) | -1.55 | -2.92 | -1.37 (-2.89 to 0.15) | 603 (6 studies) | Low | |
Fasting glucose, mg/dL (follow-up: 8-24 weeks) | -2.9 | -3.34 | -0.44 (-2.66 to 1.78) | 730 (9 studies) | Low | |
C-reactive protein, mg/L (follow-up: 8-24 weeks) | -0.2 | -0.83 | -0.63 (-1.41 to 0.15) | 371 (5 studies) | Low | |
Adiponectin, μg/mL (follow-up: 8-24 weeks) | 0.4 | 1.15 | 0.75 (0.29 to 1.21) | 181 (2 studies) | Low | |
Intermittent fastingd | ||||||
Body weight, kg (follow-up: 12-24 weeks) | -3.62 | -4.84 | -1.22 (-3.49 to 1.05) | 554 (8 studies) | Very low | |
Body mass index, kg/m2 (follow-up: 12-24 weeks) | -1.46 | -1.95 | -0.49 (-1.13 to 0.14) | 380 (5 studies) | Low | |
Waist circumference, cm (follow-up: 12-24 weeks) | -2.28 | -4.23 | -1.95 (-4.09 to 0.2) | 180 (3 studies) | Very low | |
Fat mass, kg (follow-up: 12-24 weeks) | -1.1 | -1.46 | -0.36 (-0.87 to 0.16) | 540 (8 studies) | Very low | |
Fat-free mass, kg (follow-up: 12-24 weeks) | -3.7 | -4.37 | -0.67 (-1.95 to 0.62) | 540 (8 studies) | Very low | |
Fat mass, % (follow-up: 12-24 weeks) | -0.9 | -0.63 | 0.27 (-0.48 to 1.01) | 142 (3 studies) | Very low | |
Systolic blood pressure, mm Hg (follow-up: 12-24 weeks) | -5.7 | -4.83 | 0.87 (-2.56 to 4.39) | 404 (6 studies) | Very low | |
Diastolic blood pressure, mm Hg (follow-up: 12-24 weeks) | -3.4 | -3.56 | -0.16 (-2.89 to 2.56) | 404 (6 studies) | Very low | |
Triglyceride, mg/dL (follow-up: 12-24 weeks) | -22.0 | -23.51 | -1.51 (-17.06 to 14.04) | 432 (6 studies) | Very low | |
LDL-C, mg/dL (follow-up: 12-24 weeks) | -12.48 | -12.72 | -0.24 (-5.08 to 4.59) | 387 (5 studies) | Very low | |
HDL-C, mg/dL (follow-up: 12-24 weeks) | 0.0 | -0.17 | -0.17 (-3.27 to 2.89) | 432 (6 studies) | Very low | |
HbA1c, % (follow-up: 12-24 weeks) | -0.31 | -0.20 | 0.11 (-0.04 to 0.26) | 173 (3 studies) | Very low | |
Fasting glucose, mg/dL (follow-up: 12-24 weeks) | -3.00 | -3.89 | -0.89 (-4.30 to 2.53) | 359 (5 studies) | Low | |
Fasting insulin, μU/mL (follow-up: 12-24 weeks) | -2.6 | -3.03 | -0.43 (-1.99 to 1.14) | 314 (4 studies) | Low | |
HOMA-IR (follow-up: 12-24 weeks) | -0.94 | -1.16 | -0.22 (-1.48 to 1.05) | 119 (2 studies) | Very low |
GRADE Working Group grades of evidence: High quality (Further research is very unlikely to change our confidence in the estimate of effect); Moderate quality (Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate); Low quality (Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate); Very low quality (We are very uncertain about the estimate).
CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; mLCD, moderately-low carbohydrate or low carbohydrate diet; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; HbA1c, glycosylated hemoglobin; VLCD, very-low carbohydrate diet; HOMA-IR, homeostatic model assessment for insulin resistance.
a The basis for the assumed risk is the mean change of outcomes compared to baseline in the control group across studies, and the corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group,
b mLCD for overweight/obesity: Patient or population (patients with overweight/obese), Intervention (mLCD),
Outcome |
Illustrative comparative riska (95% CI) |
No. of participants | Quality of the evidence (GRADE) | |||
---|---|---|---|---|---|---|
Assumed risk (control) |
Corresponding risk |
|||||
Intervention | Mean difference | |||||
mLCDb | ||||||
HbA1c, % (follow-up: 8-24 weeks) | -0.2 | -0.41 | -0.21 (-0.32 to -0.10) | 758 (10 studies) | Moderate | |
HOMA-IR (follow-up: 8-24 weeks) | -0.4 | -0.93 | -0.53 (-0.96 to -0.11) | 248 (3 studies) | Low | |
Fasting glucose, mg/dL (follow-up: 8-24 weeks) | 4.65 | -5.23 | -9.88 (-18.04 to -1.71) | 337 (6 studies) | Low | |
Body weight, kg (follow-up: 8-24 weeks) | -1.45 | -2.99 | -1.54 (-3.11 to 0.02) | 619 (8 studies) | Low | |
Systolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -0.25 | -3.24 | -2.99 (-5.48 to -0.49) | 510 (6 studies) | Moderate | |
Diastolic blood pressure, mm Hg (follow-up: 8-24 weeks) | 0.55 | -0.52 | -1.07 (-2.43 to 0.29) | 513 (6 studies) | Low | |
Triglyceride, mg/dL (follow-up: 8-24 weeks) | -4.0 | -21.22 | -17.22 (-34.27 to -0.18) | 742 (10 studies) | Low | |
LDL-C, mg/dL (follow-up: 8-24 weeks) | -3.6 | -3.25 | 0.35 (-3.03 to 3.72) | 607 (8 studies) | Low | |
HDL-C, mg/dL (follow-up: 8-24 weeks) | 0.2 | 2.50 | 2.30 (0.23 to 4.37) | 547 (8 studies) | Moderate | |
Hypoglycemia | There is no study directly evaluated the risk of hypoglycemia. Patients at high risk of hypoglycemia were excluded in 2 out of 13 studies. | |||||
VLCDc | ||||||
HbA1c, % (follow-up: 12-24 weeks) | -0.2 | -0.56 | -0.36 (-0.54 to -0.19) | 321 (5 studies) | Moderate | |
HOMA-IR (follow-up: 12-24 weeks) | -0.45 | -1.52 | -1.07 (-3.13 to 0.98) | 119 (2 studies) | Low | |
Fasting glucose, mg/dL (follow-up: 12-24 weeks) | -17.2 | -26.84 | -9.64 (-19.54 to 0.26) | 267 (3 studies) | Low | |
Body weight, kg (follow-up: 12-24 weeks) | -3.4 | -7.24 | -3.84 (-7.55 to -0.13) | 291 (4 studies) | Moderate | |
Systolic blood pressure, mm Hg (follow-up: 12-24 weeks) | -1.7 | -1.36 | 0.34 (-3.61 to 4.28) | 218 (3 studies) | Low | |
Diastolic blood pressure, mm Hg (follow-up: 12-24 weeks) | -2.5 | -1.12 | 1.38 (-0.90 to 3.67) | 218 (3 studies) | Low | |
Triglyceride, mg/dL (follow-up: 12-24 weeks) | -15.7 | -27.10 | -11.40 (-27.01 to 4.22) | 313 (5 studies) | Low | |
LDL-C, mg/dL (follow-up: 12-24 weeks) | -1.35 | 5.84 | 7.19 (0.02 to 14.36) | 277 (4 studies) | Moderate | |
HDL-C, mg/dL (follow-up: 12-24 weeks) | 2.3 | 2.73 | 0.43 (-1.98 to 2.84) | 312 (5 studies) | Low | |
Hypoglycemia | Although no study directly evaluated the risk of hypoglycemia, patients at high risk of hypoglycemia were excluded in 4 out of 5 studies. | |||||
Intermittent fastingd | ||||||
HbA1c, % (follow-up: 24 weeks) | -0.6 | -0.5 | 0.10 (-0.35 to 0.55) | 63 (1 study) | Low | |
HbA1c, % (follow-up: 52 weeks) | -0.5 | -0.3 | 0.20 (-0.22 to 0.62) | 137 (1 study) | Low | |
Body weight, kg (follow-up: 24 weeks) | -4.0 | -5.0 | -1.00 (-6.94 to 4.94) | 63 (1 study) | Low | |
Fat-free mass, kg (follow-up: 24 weeks) | -1.1 | -2.2 | -1.10 (-2.22 to 0.02) | 49 (1 study) | Low | |
Fat mass, kg (follow-up: 24 weeks) | -4.0 | -3.8 | 0.20 (-1.46 to 1.86) | 49 (1 study) | Low | |
Fat mass, % (follow-up: 24 weeks) | -2.1 | -1.7 | 0.40 (-0.86 to 1.66) | 49 (1 study) | Low | |
Hypoglycemia | Although no study directly evaluated the risk of hypoglycemia, most studies in obese or overweight adults have excluded patients with diabetes as an exclusion criterion. |
GRADE Working Group grades of evidence: High quality (Further research is very unlikely to change our confidence in the estimate of effect); Moderate quality (Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate); Low quality (Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate); Very low quality (We are very uncertain about the estimate).
CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; mLCD, moderately-low carbohydrate or low carbohydrate diet; HbA1c, glycosylated hemoglobin; HOMA-IR, homeostatic model assessment for insulin resistance; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; VLCD, very-low carbohydrate diet.
a The basis for the assumed risk is the mean change of outcomes compared to baseline in the control group across studies, and the corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group,
b mLCD for type 2 diabetes mellitus: Patient or population (patients with type 2 diabetes mellitus), Intervention (mLCD),
Outcome |
Illustrative comparative riska (95% CI) |
No. of participants | Quality of the evidence (GRADE) | |||
---|---|---|---|---|---|---|
Assumed risk (control) |
Corresponding risk |
|||||
Intervention | Mean difference | |||||
mLCDb | ||||||
Systolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -4.55 | -7.80 | -3.25 (-7.28 to 0.77) | 195 (2 studies) | Very low | |
Diastolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -4.00 | -5.80 | -1.80 (-4.56 to 0.96) | 93 (1 study) | Very low | |
Triglyceride, mg/dL (follow-up: 8-24 weeks) | -15.48 | -51.06 | -35.58 (-52.84 to -18.33) | 195 (2 studies) | Very low | |
LDL-C, mg/dL (follow-up: 8-24 weeks) | -0.30 | -0.30 | 0.00 (-9.55 to 9.55) | 93 (1 study) | Very low | |
HDL-C, mg/dL (follow-up: 36-52 weeks) | 2.3 | 3.90 | 1.60 (-1.13 to 4.33) | 93 (1 study) | Very low | |
Body weight, kg (follow-up: 8-24 weeks) | -6.2 | -8.01 | -1.81 (-3.93 to 0.30) | 195 (2 studies) | Very low | |
FMD, % (follow-up: 36-52 weeks) | -0.6 | -0.30 | 0.30 (-0.58 to 1.18) | 93 (1 study) | Very low | |
VLCDc | ||||||
Systolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -6.3 | -7.64 | -1.34 (-5.20 to 2.51) | 232 (2 studies) | Very low | |
Diastolic blood pressure, mm Hg (follow-up: 8-24 weeks) | -4.0 | -1.99 | 2.01 (-0.61 to 4.63) | 232 (2 studies) | Very low | |
Triglyceride, mg/dL (follow-up: 8-24 weeks) | -19.95 | -30.12 | -10.17 (-43.00 to 22.67) | 232 (2 studies) | Very low | |
LDL-C, mg/dL (follow-up: 8-24 weeks) | -6.75 | 2.16 | 8.91 (-9.27 to 27.08) | 232 (2 studies) | Very low | |
HDL-C, mg/dL (follow-up: 8-24 weeks) | 2.75 | 4.60 | 1.85 (-5.98 to 9.69) | 232 (2 studies) | Very low | |
Body weight, kg (follow-up: 8-24 weeks) | -6.05 | -7.21 | -1.16 (-2.65 to 0.34) | 232 (2 studies) | Very low | |
FMD, % (follow-up: 36-52 weeks) | -0.3 | -2.10 | -1.80 (-3.48 to -0.12) | 49 (1 study) | Very low |
GRADE Working Group grades of evidence: High quality (Further research is very unlikely to change our confidence in the estimate of effect); Moderate quality (Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate); Low quality (Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate); Very low quality (We are very uncertain about the estimate).
CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; mLCD, moderately-low carbohydrate or low carbohydrate diet; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; FMD, flow-mediated dilatation; VLCD, very-low carbohydrate diet.
Jong Han Choi
https://orcid.org/0000-0002-2667-4332
Yoon Jeong Cho
https://orcid.org/0000-0002-0960-5976
Hyun-Jin Kim
https://orcid.org/0000-0002-7885-1695
Kee-Ho Song
https://orcid.org/0000-0001-9276-6860
Ga Eun Nam
https://orcid.org/0000-0002-6739-9904
Kwang Il Kim
https://orcid.org/0000-0002-6658-047X
National Academy of Medicine of Korea