Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA.
Curr Obes Rep. 2021 Sep;10(3):409-422. doi: 10.1007/s13679-021-00451-z. Epub 2021 Jul 23.
The purpose of this review was to provide an update on the available data on the benefits of low-carbohydrate (low-carb) diets for weight management and type 2 diabetes (T2DM) and determine if low-carb diets were a settled question or still controversial.
Most of the recent published literature in this area consists of reviews of past trials, with a relatively smaller number of recent trials. Low-carb is most commonly compared to low-fat, with problematically inconsistent definitions of both. There are numerous challenges in trying to draw clear conclusions about efficacy and effectiveness. Short-term vs. long-term effects can differ, which is likely impacted by adherence. Adherence is very different between metabolic chamber or feeding studies vs. free-living. Body weight alone is a crude measure that fails to capture potentially important differences in lean-mass, fat-mass, and body water. Benefits for glycemic control need to be balanced with impacts on non-glycemic outcomes such as LDL-cholesterol, the microbiome, and inflammation. It is important to differentiate between low-carb and very-low carbohydrate diets (VLCD). To date no large-scale long-term clinical trials have been conducted testing whether low-carb diets can prevent T2DM. Many issues regarding benefits and risks of low-carb diets remain controversial or unresolved, particularly for VLCD. Some of the recent, better studies highlighted in this review suggest strategies for resolving these controversies.
本综述的目的是提供有关低碳水化合物（低碳水化合物）饮食在体重管理和 2 型糖尿病（T2DM）方面的益处的现有数据的最新信息，并确定低碳水化合物饮食是否是一个既定问题或仍有争议。
该领域最近发表的大多数文献都是对过去试验的回顾，相对较少的近期试验。低碳水化合物饮食最常与低脂肪饮食进行比较，但两者的定义都存在问题，不一致。试图得出关于疗效和有效性的明确结论存在诸多挑战。短期和长期的影响可能不同，这可能受到依从性的影响。代谢室或喂养研究与自由生活之间的依从性差异很大。体重本身是一个粗略的衡量标准，无法捕捉到瘦体重、脂肪量和身体水分的潜在重要差异。血糖控制的益处需要与非血糖结果（如 LDL 胆固醇、微生物组和炎症）的影响相平衡。区分低碳水化合物和极低碳水化合物饮食（VLCD）很重要。迄今为止，尚未进行大规模的长期临床试验来测试低碳水化合物饮食是否可以预防 T2DM。关于低碳水化合物饮食的益处和风险的许多问题仍然存在争议或未解决，特别是对于 VLCD。本综述中强调的一些最近的更好研究提出了解决这些争议的策略。
