Abstract 4363699: The Effect and Safety of Ketogenic Diets on LDL-C and other metabolic parameters compared with non-ketogenic diets among Adults with BMI Greater than 25 with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Objective: To determine the effects of a ketogenic diet on LDL-C levels and other metabolic parameters and adverse events in adults with a BMI greater than 25 and type 2 diabetes mellitus. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Studies were identified through thorough searches of PubMed, Cochrane, Google Scholar, EMBASE, HERDIN. Included studies compared a ketogenic diet (≤10% carbohydrates) to a non-ketogenic diet for at least 3 months duration in adults with a BMI ≥25 and type 2 diabetes. The primary outcome was LDL-C level. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and GRADE guidelines. Results: Nine studies with a total of 658 participants were included. In the short term (3-4 months), ketogenic diets significantly reduced LDL-C compared to non-ketogenic diets (mean difference: -0.16 mmol/L, 95% CI -0.31, -0.00, p = 0.04). This effect was not significant at longer follow-up periods (6-8 months, 12 months, and 24 months). Common adverse effects included hypoglycemia, constipation, and gastrointestinal discomfort. Conclusion: Ketogenic diets may offer short-term benefits in reducing LDL-C in overweight and obese adults with type 2 diabetes. However, these effects diminish over time, and the diet may be associated with adverse events. Significant short-term improvements were observed in HDL-C, triglycerides (TG), and HbA1c in ketogenic groups compared to controls, with moderate effects diminishing over time. Notably, follow-up time was a significant moderator for HDL-C, showing stronger effects at later time points, while FBS showed a borderline significant relationship with follow-up Long-term studies evaluating a broader range of metabolic outcomes are needed.