低碳水化合物饮食可降低代谢功能障碍相关脂肪性肝病患者的心血管危险因素水平：一项随机对照试验的系统评价和荟萃分析
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.
作者信息
Pi Shanshan, Zhang Shuwen, Zhang Junjie, Guo Yi, Li Yue, Deng Jinyan, Du Hongbo
机构信息
Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Beijing University of Chinese Medicine, Beijing, China.
出版信息
Front Nutr. 2025 Aug 26;12:1626352. doi: 10.3389/fnut.2025.1626352. eCollection 2025.
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 1,056 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.
CONCLUSION
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.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO: CRD42024603432; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024603432.
背景
低碳水化合物饮食（LCDs）越来越多地被提倡用于治疗代谢功能障碍相关脂肪性肝病（MASLD）；然而，其心血管安全性仍存在争议。本分析旨在评估LCDs对MASLD患者心血管危险因素的影响。
方法
检索了从数据库建立至2025年3月19日的PubMed、Cochrane图书馆、Web of Science和Scopus数据库。两名评审员独立进行数据提取。根据纳入研究的异质性，使用固定效应或随机效应模型进行荟萃分析。结局指标包括血压、血糖标志物、血脂谱和人体测量指标。亚组分析探讨了碳水化合物阈值（<26% vs.≥26%）和干预持续时间（<24周 vs.≥24周）。
结果
纳入了16项随机对照试验，共1056名参与者。LCDs显著降低了糖化血红蛋白（HbA1c：标准化均数差，-0.27；95%置信区间，-0.47至-0.07）、甘油三酯（TG：标准化均数差，-0.20；95%置信区间，-0.34至-0.06）、体重（标准化均数差，-0.19；95%置信区间，-0.36至-0.03）和体重指数（BMI：标准化均数差，-0.28；95%置信区间，-0.42至-0.14）。更严格的碳水化合物限制（<26%能量）进一步改善了收缩压/舒张压、稳态模型评估胰岛素抵抗指数（HOMA-IR）、HbA1c、TG、体重、BMI和腰围。短期干预（<24周）降低了HbA1c、TG和BMI。
结论
本系统评价和荟萃分析发现，LCDs与MASLD患者心血管代谢危险因素的改善有关。此外，短期实施严格的碳水化合物限制饮食方案可能会带来额外的临床益处。未来的研究应优先考虑：标准化营养评估、加强依从性策略和心血管终点试验。
系统评价注册
PROSPERO：CRD42024603432；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024603432。
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