Anagnostou, Alexandros, Larumbe-Zabala, Eneko, Fiore, Jo, Roberts, Justin and Naclerio, Fernando ORCID: https://orcid.org/0000-0001-7405-4894 (2025) 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. ISSN 1436-6207 (Print), 1436-6215 (Online) (In Press)

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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
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:	03 Dec 2025 12:33
URI:	https://gala.gre.ac.uk/id/eprint/51890

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