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

Background 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. Methods A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled clinical trials (RCTs) of carbohydrate-restricted diets and ten articles on eight RCTs of IF was performed. Results 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, 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. Conclusion Here, we describe the results of our analysis and the evidence for these recommendations.

Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hypertension

“…Adherence was assessed mainly through electronic or telephone questionnaires with a 24-hour recall. Our analysis regarding adults who were overweight or obese [3] showed that the adherence rate was 91.7% for MCD (11 out of 12 studies), 37.5% for LCD (six out of 16 studies), and 35.7% for VLCD (five out of 14 studies). Accordingly, adherence is more difficult with greater carbohydrate restriction.…”

“…For detailed research methods, see "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" published in the same issue of Diabetes and Metabolism Journal [3]. We performed a meta-analysis and systematic review on the key question: "Are carbohydrate-restricted diets helpful in improving glycemic control in patients with diabetes?"…”

“…The Joint Committee of the KDA, the Korean Society for the Study of Obesity (KSSO), and the Korean Society of Hypertension (KSH) has published a consensus statement on carbohy-Diabetes Metab J 2022;46:377-390 https://e-dmj.org drate-restricted diets and intermittent fasting in adults with obesity, type 2 diabetes mellitus (T2DM), and hypertension [3]. In this statement, we recommend a moderately-low-carbohydrate diet (MCD) or a low-carbohydrate diet (LCD) to improve glycemic control and reduce weight in patients with T2DM [3]. Despite the glucose-lowering and weight loss benefits of a very-low-carbohydrate diet (VLCD), it is strongly recommended to avoid VLCDs due to the risk of hypoglycemia and elevated low-density lipoprotein cholesterol (LDL-C) levels [3].…”

“…In this statement, we recommend a moderately-low-carbohydrate diet (MCD) or a low-carbohydrate diet (LCD) to improve glycemic control and reduce weight in patients with T2DM [3]. Despite the glucose-lowering and weight loss benefits of a very-low-carbohydrate diet (VLCD), it is strongly recommended to avoid VLCDs due to the risk of hypoglycemia and elevated low-density lipoprotein cholesterol (LDL-C) levels [3].…”

Does Aerobic plus Machine-Assisted Resistance Training Improve Vascular Function in Type 2 Diabetes? A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis

“…Lifestyle modifications, such as diet control, nutrients supply, body weight regulation, and sports exercise, are well-acknowledged to improve the prognosis of T2DM [ 4 , 5 , 6 , 7 ]. Sports exercise can be divided into aerobic training, resistance training, or combination.…”