Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease

Hansen, Camilla Dalby; Gram-Kampmann, Eva-Marie; Hansen, Johanne Kragh; Hugger, Mie Balle; Madsen, Bjørn Stæhr; Jensen, Jim; Olesen, Sara; Torp, Nikolaj; Rasmussen, Ditlev Nytoft; Kjærgaard, Maria; Johansen, Stine Liv; Lindvig, Katrine Prier; Andersen, Peter; Thorhauge, Katrine; Brønd, Jan Christian; Hermann, Anne Pernille; Beck‐Nielsen, Henning; Detlefsen, Sönke; Hansen, Torben; Højlund, Kurt; Thiele, Maja; Israelsen, Mads; Krag, Aleksander

doi:10.7326/m22-1787

Cited by 40 publications

(39 citation statements)

References 38 publications

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“…A healthy diet is a cornerstone in the prevention and treatment of obesity and related metabolic conditions such as NAFL. Low-carbohydrate and low-fat diets have both been shown to be effective in reducing liver fat in overweight individuals [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Replacing Foods with a High-Glycemic Index and High in Saturated Fat by Alternatives with a Low Glycemic Index and Low Saturated Fat Reduces Hepatic Fat, Even in Isocaloric and Macronutrient Matched Conditions

et al. 2023

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Background: Current guidelines aim to limit the dietary glycemic index (GI) and intake of saturated fatty acids (SFA). Several studies have shown favorable effects of low-GI or low-SFA diets on intrahepatic lipid content (IHL), but these studies were performed under overfeeding conditions or extreme differences in GI or SFA to maximize the contrast between diets. By combining changes in GI and SFA, we can mimic how people can improve their diet in a realistic setting. Objectives: We investigated the effect on liver fat content and substrate metabolism of both reducing GI and replacing SFA with polyunsaturated fat in practically realistic amounts under isocaloric conditions. Design and Methods: In a randomized crossover study, thirteen overweight participants consumed two diets, one high in GI and SFA (high GI/SFA) and one low in GI and SFA (low GI/SFA) with identical macronutrient composition, for two weeks each. Diets were equal in caloric content, consisted of habitual food items, and had a macronutrient composition that can be easily achieved in daily life. At the end of each intervention, IHL content/composition and liver glycogen were measured by magnetic resonance spectroscopy. Additionally, fasted and postprandial hepatic de novo lipogenesis and glycemic and metabolic responses were investigated. Results: IHL was significantly lower (−28%) after the two-week low-GI/SFA diet (2.4 ± 0.5% 95% CI [1.4, 3.4]) than after the two-week high-GI/SFA diet (3.3 ± 0.6% 95% CI [1.9, 4.7], p < 0.05). Although hepatic glycogen content, hepatic de novo lipogenesis, hepatic lipid composition, and substrate oxidation during the night were similar between the two diets, the glycemic response to the low-GI/SFA diet was reduced (p < 0.05). Conclusions: Changes in macronutrient quality can already have drastic effects on liver fat content and postprandial glycemia after two weeks and even when energy content and the percentage of total fat and carbohydrate remains unchanged.

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Section: Introductionmentioning

confidence: 99%

Replacing Foods with a High-Glycemic Index and High in Saturated Fat by Alternatives with a Low Glycemic Index and Low Saturated Fat Reduces Hepatic Fat, Even in Isocaloric and Macronutrient Matched Conditions

et al. 2023

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“…Since a lowcarbohydrate diet can effectively decrease blood glucose, why do the medical associations not recommend a lowcarbohydrate diet for patients with type 2 diabetes? Perhaps because there are not many rigorous, long-term studies on medical nutrition therapy (similar to the study by Hansen et al 2 ) with robust and consistent results. Moreover, dietary habits and staple foods of people with type 2 diabetes vary from place to place, and such a lowcarbohydrate diet may not be acceptable to many people.…”

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confidence: 96%

“…Type 2 diabetes and NAFLD share a common pathogenic mechanism of insulin resistance. Approximately 55-70% of patients with type 2 diabetes have NAFLD, and type 2 diabetes exacerbates the inflammation of NAFLD 2 . A study by Hansen et al 2 provided useful insights into the effects of calorie-unrestricted low-carbohydrate, high-fat diet vs highcarbohydrate, low-fat diet in patients with type 2 diabetes and nonalcoholic fatty liver disease.…”

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confidence: 99%

“…Systematic reviews have shown that a lowcarbohydrate diet can significantly lower hemoglobin A1c 1,3,4 . Hansen et al 2 conducted a 6 month randomized trial of calorie-unrestricted low-carbohydrate, high-fat [LCHF: carbohydrate <20 energy percent (E%), fat 50-60 E%, and protein 25-30 E%] vs high-carbohydrate, low-fat (HCLF: carbohydrate 50-60 E%, fat 20-30 E%, and protein 20-25 E%) diet in patients with type 2 diabetes and nonalcoholic fatty liver disease. During the 6th month of dietary intervention, the LCHF and HCLF groups consumed a mean total energy of 1702 and 1618 kcal/day, with 15.0% and 45.7% of carbohydrate, 59.4% and 28.3% of fat, respectively; they showed weight loss of 5.5 and 1.7 kg, blood glucose of 25.4 and 10.63 mg/dL, and hemoglobin A1c of 0.88% and 0.29%, respectively.…”

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confidence: 99%

“…Studies have also shown that low-carbohydrate and high-fat diets can increase satiety and decrease appetite to reduce body weight 1,3 . Although a lower percentage of a lowcarbohydrate diet is more effective in lowering blood glucose, it also has more side effects and is less likely to be maintained over time 2 . In this study, 3 months after the end of the study (month 9), the difference in blood glucose lowering and body weight between the LCHF and HCLF groups was insignificant.…”

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confidence: 99%

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