School of Nutrition and Exercise Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital (RBWH), Herston, Queensland, Australia.
Nutr Diet. 2021 Feb;78(1):41-56. doi: 10.1111/1747-0080.12649. Epub 2020 Dec 6.
Very low carbohydrate high fat diets (VLCHF) are increasingly popular for weight loss and diabetes management, but the risk implications of long-term adherence to a high-fat-diet remain unclear, especially in high-risk populations. This review aimed to examine adherence, weight loss, diabetes- and cardiovascular disease (CVD)-related risk markers in adults consuming VLCHF diets.
Online databases were searched for randomised controlled trials ≥3 months duration that met a pre-defined macronutrient prescription: VLCHF ≤25%E carbohydrate, >35%E fat; low fat (LF) ≥45%E carbohydrate, ≤30%E fat; and reported energy, saturated fat (SFA), weight, blood glucose, cholesterol and blood pressure (BP). Studies were excluded if the macronutrient prescription was not targeted (n = 32); not met (n = 17) or not reported (n = 13).
Eight studies included: 1217 commenced; 922 completed overweight and obese adults. Diets were isocaloric moderately energy-restricted, closely monitored with ongoing support from dietitians, physicians, and/or nurses. Four studies reported non-adherence beyond 3 months (n = 3) and 6 months (n = 1) despite interventions of 12, 15 and 24 months. VLCHF diets were high in fat and SFA (fat 49%-56%E; SFA 11%-21%E) compared to LF diets (fat 13%-29%E; SFA 5%-11%E). All groups achieved significant weight loss and improvements in BP and blood glucose. LDL-C reduction favoured LF, P < .05; increased HDL-C and reduced triglyceride levels favoured VLCHF, P < .05.
VLCHF and LF diets with moderate energy restriction demonstrate similar weight loss and improvements to BP to 3 months. However, adherence is likely poor without intensive support from health professionals. Dietary SFA should be monitored to ensure recommended intakes, but longer-term studies with high adherence are required to confirm the level of CVD-risk and potential harms.
极低碳水化合物高脂肪饮食（VLCHF）在减肥和糖尿病管理方面越来越受欢迎，但长期遵循高脂肪饮食的风险仍不清楚，特别是在高危人群中。本综述旨在研究成年人摄入 VLCHF 饮食时的依从性、体重减轻、糖尿病和心血管疾病（CVD）相关风险标志物。
在线数据库中搜索了持续时间至少为 3 个月的随机对照试验，这些试验符合预先确定的宏量营养素处方：VLCHF ≤25%E 碳水化合物，>35%E 脂肪；低脂肪（LF）≥45%E 碳水化合物，≤30%E 脂肪；并报告能量、饱和脂肪（SFA）、体重、血糖、胆固醇和血压（BP）。如果宏量营养素处方不是目标（n = 32）、不满足（n = 17）或未报告（n = 13），则排除研究。
纳入 8 项研究：共纳入 1217 例患者，922 例患者完成了超重和肥胖成年人的研究。饮食是等热量、中度能量限制，由营养师、医生和/或护士进行密切监测和持续支持。尽管进行了 12、15 和 24 个月的干预，但有 4 项研究报告了 3 个月（n = 3）和 6 个月（n = 1）以上的不依从性。与 LF 饮食（脂肪 13%-29%E；SFA 5%-11%E）相比，VLCHF 饮食的脂肪和 SFA 含量较高（脂肪 49%-56%E；SFA 11%-21%E）。所有组均实现了显著的体重减轻和血压及血糖改善。LDL-C 降低有利于 LF，P<.05；增加 HDL-C 和降低甘油三酯水平有利于 VLCHF，P<.05。
VLCHF 和 LF 饮食与适度能量限制相结合，在 3 个月时可达到相似的体重减轻和血压改善效果。然而，如果没有来自健康专业人员的密集支持，依从性可能很差。应监测膳食 SFA 以确保建议的摄入量，但需要进行更高依从性的长期研究，以确认 CVD 风险水平和潜在危害。
