Anagnostou, Alexandros, Larumbe-Zabala, Eneko, Fiore, Jo, Roberts, Justin and Naclerio, Fernando ORCID: https://orcid.org/0000-0001-7405-4894 (2026) Effects of energy-matched low- versus high-carbohydrate diets on glycaemic control, lipid profile, and body composition in healthy adults: a systematic review and meta-analysis of randomised controlled trials. European Journal of Nutrition, 65:19. ISSN 1436-6207 (Print), 1436-6215 (Online) (doi:10.1007/s00394-025-03862-z)

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Abstract

Background: The comparative effects of energy-matched low-carbohydrate (LC) versus high-carbohydrate (HC) diets on metabolic and anthropometric outcomes in healthy adults remain unclear.
Objective: To evaluate the effects of LC diets (≤44% of total daily caloric intake [TDCI] from carbohydrate) versus HC diets (≥45% TDCI) on fasting glycaemia, insulinaemia, blood lipids, and body composition in non-medicated, disease-free adults under energy-matched conditions.
Methods: Randomised controlled trials (RCTs) were identified through systematic searches of PubMed and secondary sources up to April 2025. Eligible studies compared energy-matched dietary interventions and reported pre- and post-intervention data for fasting blood glucose (FBG), fasting insulin (FINS), blood lipids (total cholesterol [TC], HDL-cholesterol [HDL-C], LDL-cholesterol [LDL-C], triglycerides [TAG]), and/or body composition. Pooled effect sizes (Hedges’ g) and 95% confidence intervals (CIs) were calculated using a random-effects model.
Results: Eighteen RCTs involving 905 participants met the inclusion criteria. LC diets produced greater reductions in FBG (g = −0.364; 95% CI: −0.709 to −0.019; P < 0.001) and FINS (g = −0.190; 95% CI: −0.361 to −0.014; P = 0.034) compared with HC. TAG decreased (g = −0.379; 95% CI: −0.540 to −0.219; P < 0.001), and HDL-C increased (g = 0.389; 95% CI: 0.229 to 0.550; P < 0.001) under LC diets. HC diets led to a greater reduction in LDL-C (g = −0.225; 95% CI: −0.406 to −0.043; P = 0.009). No significant effects were found for TC. LC diets also reduced body mass (g = −0.183; 95% CI: −0.349 to −0.017; P = 0.031) and fat mass (g = −0.304; 95% CI: −0.548 to −0.059; P = 0.015) to a greater extent than HC, with no effect on fat-free mass.
Conclusion: Under energy-matched conditions, LC confers modest advantages for glycaemia, HDL-C, and TAG, whereas HC better lowers LDL-C. Most effects do not depend on exercise status, offering evidence to guide carbohydrate intake recommendations in diets where total caloric intake remains unchanged.

Item Type:	Article
Additional Information:	"Crown Sports Nutrition and the University of Greenwich provided joint funding for the development of research projects comparing the effects of nutritional intervention differing by CHO intake, on markers of health, body composition and physical performance. This funding was used to help in the preparation of this review but did not affect its purpose or content."
Uncontrolled Keywords:	insulin resistance, Triglycerides, energy-matched diets, macronutrient distribution, systematic review methodology
Subjects:	Q Science > Q Science (General) R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC1200 Sports Medicine
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	08 Jan 2026 15:15
URI:	https://gala.gre.ac.uk/id/eprint/51890

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