SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1626352
Low-Carbohydrate Diets Reduce Cardiovascular Risk Factor Levels in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- 1Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- 2Beijing University of Chinese Medicine, Beijing, China
- 3Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- 4Liver Diseases Academy of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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BACKGROUND: Low-carbohydrate diets (LCDs) are increasingly advocated for the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD); however, their cardiovascular safety profile remains controversial. This analysis aims to evaluate the effects of LCDs on cardiovascular risk factors in MASLD patients. METHODS: PubMed, Cochrane Library, Web of Science, and Scopus were searched from inception to March 19, 2025. Two reviewers independently conducted data extraction. Meta-analyses were performed using fixed-effects or random-effects models, as determined by the heterogeneity of the included studies. Outcomes included blood pressure, glycemic markers, lipid profiles, and anthropometric indicators. Subgroup analyses explored carbohydrate thresholds (< 26% vs. ≥ 26%) and intervention durations (< 24 weeks vs. ≥ 24 weeks). RESULTS: Sixteen RCTs comprising 1056 participants were included. LCDs significantly reduced glycated hemoglobin (HbA1c: SMD, -0.27; 95% CI, -0.47 to -0.07), triglyceride (TG: SMD, -0.20; 95% CI, -0.34 to -0.06), body weight (SMD, -0.19; 95% CI, -0.36 to -0.03), and body mass index (BMI: SMD, -0.28; 95% CI, -0.42 to -0.14). Stricter carbohydrate restriction (< 26% energy) further improved systolic/diastolic blood pressure, homeostatic model assessment insulin resistance index (HOMA-IR), HbA1c, TG, body weight, BMI, and waist circumference. Short-term interventions (< 24 weeks) lowered HbA1c, TG, and BMI. CONCLUSIONS: This systematic review and meta-analysis found that LCDs are associated with improvements in cardiometabolic risk factors among patients with MASLD. Furthermore, short-term implementation of a strict carbohydrate-restricted dietary regimen may yield additional clinical benefits. Future research should prioritize: standardized nutrient assessment, enhanced adherence strategies, and cardiovascular endpoint trials.
Keywords: Low-carbohydrate diet, nonalcoholic fatty liver disease, Metabolic dysfunction-associated steatotic liver disease, Metabolic dysfunction-associated fatty liver disease, cardiovascular risk factor
Received: 10 May 2025; Accepted: 08 Aug 2025.
Copyright: © 2025 Pi, Zhang, Zhang, Guo, Li, Deng and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongbo Du, Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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