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Background <p>The comparative effects of energy-matched low-carbohydrate (LC) versus high-carbohydrate (HC) diets on metabolic and anthropometric outcomes in healthy adults remain unclear.</p> Objective <p>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.</p> Methods <p>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.</p> Results <p>Eighteen RCTs involving 905 participants met the inclusion criteria. LC diets produced greater reductions in FBG (<i>g</i> = − 0.364; 95% CI − 0.709 to −&#xa0;0.019; <i>P</i> &lt; 0.001) and FINS (<i>g</i> = − 0.190; 95% CI − 0.361 to − 0.014; <i>P</i> = 0.034) compared with HC. TAG decreased (<i>g</i> = − 0.379; 95% CI − 0.540 to − 0.219; <i>P</i> &lt; 0.001), and HDL-C increased (<i>g</i> = 0.389; 95% CI 0.229 to 0.550; <i>P</i> &lt; 0.001) under LC diets. HC diets led to a greater reduction in LDL-C (<i>g</i> = −  0.225; 95% CI − 0.406 to − 0.043; <i>P</i> = 0.009). No significant effects were found for TC. LC diets also reduced body mass (<i>g</i> = − 0.183; 95% CI − 0.349 to − 0.017; <i>P</i> = 0.031) and fat mass (<i>g</i> = − 0.304; 95% CI −  0.548 to − 0.059; <i>P</i> = 0.015) to a greater extent than HC, with no effect on fat-free mass.</p> Conclusion <p>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.</p>

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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

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  • 发表日期：

    2026年1月6日

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  • Alexandros Anagnostou,
  • Eneko Larumbe-Zabala,
  • Jo Fiore,
  • Justin Roberts,
  • Fernando Naclerio

摘要

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.