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Objective <p>Systematic evaluation of the efficacy and safety of lower-carbohydrate dietary patterns (LCDP) in metabolic associated fatty liver disease (MAFLD).</p> Methods <p>The literature search was conducted in 8 databases, covering all relevant randomized controlled trials on LCDP intervention for MAFLD patients from the database establishment to June 1, 2025. The quality of the literature was evaluated using the Cochrane Bias Risk Assessment Tool. The extracted data were analyzed using Review Manager 5.3 software for meta-analysis. Sensitivity analysis and publication bias detection were performed using Stata 18.0 software.</p> Results <p>The study included 9 randomized controlled trials (RCTs) that met the criteria, involving 408 MAFLD patients and covering 18 outcome measures related to anthropometry, liver function, blood pressure, blood lipids, and blood glucose. The study results indicate that LCDP can significantly affect the body weight (BW) and its 95% confidence intervals (CI) is -4.09&#xa0;kg[-7.36, -0.81]; waist circumference (WC) -4.84&#xa0;cm[-5.46, -4.23]; body mass index (BMI) -1.60&#xa0;kg/m<sup>2</sup>[-2.41, -0.79]; diastolic blood pressure (DBP) -3.47mmHg[-5.23, -1.71]; triglycerides (TG) -0.45mmol/L[-0.73, -0.17]; fasting plasma glucose (FPG) -0.33mmol/L[-0.60, -0.06] and homeostatic model assessment of insulin resistance (HOMA-IR) -1.57[-2.52, -0.62] levels in patients with MAFLD. Subgroup analysis based on dietary subtypes showed that low carbohydrate diets (LCD) significantly affect the alanine aminotransferase (ALT) -6.82U/L[-12.15, -1.49] levels in MAFLD patients. Very low carbohydrate, high-fat ketogenic diets (VLCKD) can significantly affect the BW -4.62&#xa0;kg[-8.10, -1.14]; WC -4.90&#xa0;cm[-5.53, -4.28]; waist-to-hip ratio (WHR) -0.03[-0.05, -0.01]; BMI − 1.68&#xa0;kg/m<sup>2</sup>[-2.64, -0.71]; TG -0.56mmol/L[-0.87, -0.24]; glycated hemoglobin (HbAlc) -0.61%[-1.13, -0.09] and HOMA-IR -2.27[-4.01, -0.54] in MAFLD patients. When the LCDP intervention cycle is 8 weeks, it may had no significant effect in MAFLD patients. When the intervention period is 12 weeks, it can significantly affect the BW -6.03&#xa0;kg[-8.99, -3.07]; WC -4.88&#xa0;cm[-5.50, -4.26]; BMI − 2.33&#xa0;kg/m<sup>2</sup>[-2.61, -2.06]; HOMA-IR -1.44[-2.35, -0.52]; HbA1c -0.61%[-1.13, -0.09]; TG -0.50mmol/L[-0.98, -0.02]; aspartate transaminase (AST) -6.19U/L[-8.85, -3.54] and ALT − 17.09U/L[-26.40, -7.78] in MAFLD patients, and significantly affect the low-density lipoprotein cholesterol (LDL-C) + 0.22mmol/L[0.17, 0.27] in MAFLD patients. Adverse events were reported in 1 trial, commonly including dyspepsia, nausea, and found diet difficult to implement, etc. Although there is some heterogeneity in the study, the results are stable and there is no clear evidence of small-study effects.</p> Conclusion <p>LCDP can improve obesity and insulin resistance (IR) in MAFLD patients, and has a layered mechanism for regulating blood pressure. Its short-term effects on liver enzymes, visceral organs, and liver fat are limited, high saturated fat may weaken its effect on improving serum cholesterol.</p>

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Efficacy and safety of lower-carbohydrate dietary patterns for metabolic associated fatty liver disease: evidence from randomized controlled trials with grade analysis

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  • 发表日期：

    2026年1月19日

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  • Yunhang Chu,
  • Ming Yang,
  • Qi Meng,
  • Delong Cong,
  • Lingyu Xu,
  • Peng Dai,
  • Ziqiang Chen,
  • Sulan Chen,
  • Rui Zhang,
  • Yan Leng

摘要

Objective

Systematic evaluation of the efficacy and safety of lower-carbohydrate dietary patterns (LCDP) in metabolic associated fatty liver disease (MAFLD).

Methods

The literature search was conducted in 8 databases, covering all relevant randomized controlled trials on LCDP intervention for MAFLD patients from the database establishment to June 1, 2025. The quality of the literature was evaluated using the Cochrane Bias Risk Assessment Tool. The extracted data were analyzed using Review Manager 5.3 software for meta-analysis. Sensitivity analysis and publication bias detection were performed using Stata 18.0 software.

Results

The study included 9 randomized controlled trials (RCTs) that met the criteria, involving 408 MAFLD patients and covering 18 outcome measures related to anthropometry, liver function, blood pressure, blood lipids, and blood glucose. The study results indicate that LCDP can significantly affect the body weight (BW) and its 95% confidence intervals (CI) is -4.09 kg[-7.36, -0.81]; waist circumference (WC) -4.84 cm[-5.46, -4.23]; body mass index (BMI) -1.60 kg/m2[-2.41, -0.79]; diastolic blood pressure (DBP) -3.47mmHg[-5.23, -1.71]; triglycerides (TG) -0.45mmol/L[-0.73, -0.17]; fasting plasma glucose (FPG) -0.33mmol/L[-0.60, -0.06] and homeostatic model assessment of insulin resistance (HOMA-IR) -1.57[-2.52, -0.62] levels in patients with MAFLD. Subgroup analysis based on dietary subtypes showed that low carbohydrate diets (LCD) significantly affect the alanine aminotransferase (ALT) -6.82U/L[-12.15, -1.49] levels in MAFLD patients. Very low carbohydrate, high-fat ketogenic diets (VLCKD) can significantly affect the BW -4.62 kg[-8.10, -1.14]; WC -4.90 cm[-5.53, -4.28]; waist-to-hip ratio (WHR) -0.03[-0.05, -0.01]; BMI − 1.68 kg/m2[-2.64, -0.71]; TG -0.56mmol/L[-0.87, -0.24]; glycated hemoglobin (HbAlc) -0.61%[-1.13, -0.09] and HOMA-IR -2.27[-4.01, -0.54] in MAFLD patients. When the LCDP intervention cycle is 8 weeks, it may had no significant effect in MAFLD patients. When the intervention period is 12 weeks, it can significantly affect the BW -6.03 kg[-8.99, -3.07]; WC -4.88 cm[-5.50, -4.26]; BMI − 2.33 kg/m2[-2.61, -2.06]; HOMA-IR -1.44[-2.35, -0.52]; HbA1c -0.61%[-1.13, -0.09]; TG -0.50mmol/L[-0.98, -0.02]; aspartate transaminase (AST) -6.19U/L[-8.85, -3.54] and ALT − 17.09U/L[-26.40, -7.78] in MAFLD patients, and significantly affect the low-density lipoprotein cholesterol (LDL-C) + 0.22mmol/L[0.17, 0.27] in MAFLD patients. Adverse events were reported in 1 trial, commonly including dyspepsia, nausea, and found diet difficult to implement, etc. Although there is some heterogeneity in the study, the results are stable and there is no clear evidence of small-study effects.

Conclusion

LCDP can improve obesity and insulin resistance (IR) in MAFLD patients, and has a layered mechanism for regulating blood pressure. Its short-term effects on liver enzymes, visceral organs, and liver fat are limited, high saturated fat may weaken its effect on improving serum cholesterol.