Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension

Abstract

Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.

Keywords: Carbohydrates; Diabetes mellitus; Diet; Hypertension; Obesity.

Fig. 1.

Effects of carbohydrate-restricted diets on body weight in adults with overweight/obesity. (A) Moderately-low carbohydrate or low carbohydrate diet (mLCD). (B) Very-low carbohydrate diet (VLCD). WMD, weighted mean difference; CI, confidence interval.

Fig. 2.

Effects of carbohydrate-restricted diets on glycosylated hemoglobin (HbA1c) in adults with type 2 diabetes mellitus. (A) Moderately-low carbohydrate or low carbohydrate diet (mLCD). (B) Very-low carbohydrate diet (VLCD). WMD, weighted mean difference; CI, confidence interval.

Fig. 3.

Effects of carbohydrate-restricted diets on systolic and diastolic blood pressure in adults with hypertension. (A) Moderately-low carbohydrate or low carbohydrate diet (mLCD). (B) Very-low carbohydrate diet (VLCD). WMD, weighted mean difference; CI, confidence interval.