Metabolic Diseases Research Unit, National Institute for Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico; Tecnologico de Monterrey, School of Medicine, Mexico City, Mexico.
Metabolic Diseases Research Unit, National Institute for Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico; National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico.
Am J Clin Nutr. 2024 Mar;119(3):740-747. doi: 10.1016/j.ajcnut.2024.01.009. Epub 2024 Jan 17.
Low-density lipoprotein (LDL) cholesterol change with consumption of a low-carbohydrate diet (LCD) is highly variable. Identifying the source of this heterogeneity could guide clinical decision-making.
To evaluate LDL cholesterol change in randomized controlled trials involving LCDs, with a focus on body mass index (BMI) in kg/m.
Three electronic indexes (Pubmed, EBSCO, and Scielo) were searched for studies between 1 January, 2003 and 20 December, 2022. Two independent reviewers identified randomized controlled trials involving adults consuming <130 g/d carbohydrate and reporting BMI and LDL cholesterol change or equivalent data. Two investigators extracted relevant data, which were validated by other investigators. Data were analyzed using a random-effects model and contrasted with results of pooled individual participant data.
Forty-one trials with 1379 participants and a mean intervention duration of 19.4 wk were included. In a meta-regression accounting for 51.4% of the observed variability on LCDs, mean baseline BMI had a strong inverse association with LDL cholesterol change [β = -2.5 mg/dL/BMI unit, 95% confidence interval (CI): -3.7, -1.4], whereas saturated fat amount was not significantly associated with LDL cholesterol change. For trials with mean baseline BMI <25, LDL cholesterol increased by 41 mg/dL (95% CI: 19.6, 63.3) on the LCD. By contrast, for trials with a mean of BMI 25-<35, LDL cholesterol did not change, and for trials with a mean BMI ≥35, LDL cholesterol decreased by 7 mg/dL (95% CI: -12.1, -1.3). Using individual participant data, the relationship between BMI and LDL cholesterol change was not observed on higher-carbohydrate diets.
A substantial increase in LDL cholesterol is likely for individuals with low but not high BMI with consumption of an LCD, findings that may help guide individualized nutritional management of cardiovascular disease risk. As carbohydrate restriction tends to improve other lipid and nonlipid risk factors, the clinical significance of isolated LDL cholesterol elevation in this context warrants investigation. This trial was registered at PROSPERO as CRD42022299278.
低碳水化合物饮食（LCD）对低密度脂蛋白（LDL）胆固醇的影响差异很大。确定这种异质性的来源可以指导临床决策。
评估涉及 LCD 的随机对照试验中 LDL 胆固醇的变化，重点关注体重指数（BMI）kg/m。
2003 年 1 月 1 日至 2022 年 12 月 20 日，三个电子索引（Pubmed、EBSCO 和 Scielo）搜索了涉及成年人摄入<130 g/d 碳水化合物和报告 BMI 和 LDL 胆固醇变化或等效数据的随机对照试验。两名独立评审员确定了涉及成年人摄入<130 g/d 碳水化合物和报告 BMI 和 LDL 胆固醇变化或等效数据的随机对照试验。两名调查员提取了相关数据，其他调查员对数据进行了验证。使用随机效应模型进行数据分析，并与汇总个体参与者数据的结果进行对比。
纳入了 41 项涉及 1379 名参与者、平均干预时间为 19.4 周的试验。在一个考虑到 LCD 上观察到的变异性的 51.4%的 meta 回归中，平均基线 BMI 与 LDL 胆固醇变化呈强烈的负相关[β = -2.5 mg/dL/BMI 单位，95%置信区间（CI）：-3.7，-1.4]，而饱和脂肪量与 LDL 胆固醇变化无显著相关性。对于平均基线 BMI<25 的试验，在 LCD 上 LDL 胆固醇增加了 41 mg/dL（95%CI：19.6，63.3）。相比之下，对于平均 BMI 为 25-<35 的试验，LDL 胆固醇没有变化，而对于平均 BMI≥35 的试验，LDL 胆固醇下降了 7 mg/dL（95%CI：-12.1，-1.3）。使用个体参与者数据，在较高碳水化合物饮食中未观察到 BMI 与 LDL 胆固醇变化之间的关系。
对于摄入 LCD 的低 BMI 但非高 BMI 个体，LDL 胆固醇可能会显著升高，这一发现可能有助于指导心血管疾病风险的个体化营养管理。由于碳水化合物限制往往会改善其他血脂和非血脂危险因素，因此在这种情况下孤立性 LDL 胆固醇升高的临床意义值得进一步研究。本试验在 PROSPERO 注册为 CRD42022299278。
