This RCT evaluated the cardiometabolic effects of ~10% weight loss achieved by three diets — very-low-carbohydrate ketogenic, Mediterranean, and very-low-fat plant-forward — in adults with metabolically unhealthy obesity (prediabetes and hepatic steatosis).
All three diets increased muscle insulin sensitivity by ~50%, but the very-low-carbohydrate diet produced a 2–3× greater improvement in hepatic insulin sensitivity (p < 0.001) and larger reductions in intrahepatic triglycerides, hepatic de novo lipogenesis, HbA1c, and 24-h plasma glucose and insulin; LDL-cholesterol, apolipoprotein B, and 24-h triglycerides did not differ across groups.
Full text was inaccessible; sample size, blinding details, and duration of intervention cannot be confirmed from the abstract alone. Long-term sustainability and cardiometabolic outcomes beyond the ~10% weight-loss endpoint are unknown.
For patients with metabolically unhealthy obesity, prediabetes, and hepatic steatosis, a very-low-carbohydrate diet may offer superior hepatic metabolic benefits over Mediterranean or very-low-fat diets at equivalent weight loss — without worsening LDL or apolipoprotein B. Clinicians can consider this diet preferentially when hepatic insulin resistance and fatty liver are primary concerns.
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