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Health Economics

Are low carbohydrate diet interventions beneficial for metabolic syndrome and its components? A systematic review and meta-analysis of randomized controlled trials

International Journal of Obesity volume 49, pages 1252–1263 (2025)Cite this article

Subjects

Abstract

Background

Diet plays a crucial role in metabolic syndrome (MetS) which might develop into diabetes mellitus and cardiovascular disease.

Objective

We aimed to evaluate the effects of low-carbohydrate diet (LCD) interventions on MetS and its components.

Methods

Four electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Medline were selected from database inception until March 2024. Randomized clinical trials in adults with MetS evaluated LCD interventions (50–130 g of carbohydrates/day or 10–40% of total dietary energy at 2000 kcal/day) and a control intervention for at least 12 weeks. Four reviewers independently extracted data and assessed risk of bias using Cochrane tool. Meta-analyses used a random-effects model to calculate mean differences (MD) and 95% confidence intervals (CI) and analyzed heterogeneity, sensitivity, and publication bias.

Results

A total of 41 articles satisfied the study’s inclusion criteria. Thirty articles were incorporated in the meta-analysis, of which 25 were high-quality studies and 5 were of moderate quality. In total, 3806 adults were assessed. Pooled analysis of mean differences (MD) indicated that compared to the control dietary intervention, the LCD intervention reduced BMI (MD −0.43 kg/m2, 95% CI −0.75, −0.11), waist circumference (MD −0.77 cm, 95% CI −1.43, −0.12), systolic blood pressure (MD −1.19 mmHg, 95% CI −2.36, −0.02), diastolic blood pressure (MD −1.49 mmHg, 95% CI −2.36, −0.02), HbA1c (MD −0.62%, 95% CI −0.91, −0.32) and triglycerides (MD −0.24 mmol/L, 95% CI −0.42, −0.05), and increased high-density lipoprotein cholesterol (MD 0.06 mmol/l, 95% CI 0.03, 0.09). The subgroup analysis results indicated that the source of high heterogeneity might come from the dosage of intervention.

Conclusion

In summary, LCD interventions improved MetS-related biomarkers in adults with MetS. Moreover, further research is needed to determine the optimal intervention period of LCD on MetS.

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Fig. 1: The flowchart conforms to the Preferred Reporting Items for Systematic Evaluation and Meta-Analysis (PRISMA) protocol recommendations.
Fig. 2: Summary of risk of bias for 30 studies with randomized controlled trials using the Cochrane Risk of Bias Tool (Cochrane Handbook, version 5.1.0) for study quality assessment.

Data availability

Data are available from the corresponding authors upon reasonable request.

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Author notes

  1. These authors contributed equally: Qi Zheng, Xin Gao, Xiang Ruan.

Authors and Affiliations

  1. Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei, China

    Qi Zheng, Xin Gao, Siju Chen, Zhouchen Yu, Die Li & Jinxia Zhai

  2. School of the First Clinical Medicine, Anhui Medical University, Heifei, China

    Xiang Ruan & Xingchen Pan

  3. School of Public Health, Anhui Medical University, Hefei, Anhui, China

    Ruotong Wang

  4. Clinical college, Anhui Medical University, Hefei, China

    Lanjian Zhao

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  1. Qi Zheng
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  2. Xin Gao
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  8. Zhouchen Yu
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  10. Jinxia Zhai
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Contributions

JXZ and QZ designed and finalized the topic of this meta-analysis. JXZ, QZ, XG, SJC, ZCY and DL helped write the manuscript. QZ, XR, RTW, and LJZ screened the articles, XG intervened to resolve disputes. QZ, XR, RTW, and LJZ completed the study quality scores. XCP meta-analyzed the data. All authors contributed to the article and approved the final version.

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Correspondence to Jinxia Zhai.

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Zheng, Q., Gao, X., Ruan, X. et al. Are low carbohydrate diet interventions beneficial for metabolic syndrome and its components? A systematic review and meta-analysis of randomized controlled trials. Int J Obes 49, 1252–1263 (2025). https://doi.org/10.1038/s41366-025-01822-5

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  • DOI: https://doi.org/10.1038/s41366-025-01822-5

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