Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis
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{"title"=>"Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: A systematic review and meta-analysis", "type"=>"generic", "authors"=>[{"first_name"=>"Celeste E.", "last_name"=>"Naude", "scopus_author_id"=>"36718003800"}, {"first_name"=>"Anel", "last_name"=>"Schoonees", "scopus_author_id"=>"55224054600"}, {"first_name"=>"Marjanne", "last_name"=>"Senekal", "scopus_author_id"=>"6601972826"}, {"first_name"=>"Taryn", "last_name"=>"Young", "scopus_author_id"=>"12239527700"}, {"first_name"=>"Paul", "last_name"=>"Garner", "scopus_author_id"=>"7102107652"}, {"first_name"=>"Jimmy", "last_name"=>"Volmink", "scopus_author_id"=>"7004095875"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"sgr"=>"84904101466", "doi"=>"10.1371/journal.pone.0100652", "pui"=>"373506527", "pmid"=>"25007189", "scopus"=>"2-s2.0-84904101466", "issn"=>"19326203", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)"}, "id"=>"aa28c07a-cfa6-30f4-ac4a-1fd55ebab3d1", "abstract"=>"BACKGROUND: Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets.\\n\\nMETHODS AND FINDINGS: We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3-6 months and 1-2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects meta-analysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3-6 months (MD 0.74 kg, 95%CI -1.49 to 0.01 kg; I2 = 53%; n = 1745, 14 trials; moderate quality evidence) and 1-2 years (MD 0.48 kg, 95%CI -1.44 kg to 0.49 kg; I2 = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3-6 months and 1-2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (>914 participants). In diabetic participants, findings showed a similar pattern.\\n\\nCONCLUSIONS: Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.", "link"=>"http://www.mendeley.com/research/low-carbohydrate-versus-isoenergetic-balanced-diets-reducing-weight-cardiovascular-risk-systematic-r", "reader_count"=>310, "reader_count_by_academic_status"=>{"Unspecified"=>6, "Professor > Associate Professor"=>6, "Librarian"=>4, "Researcher"=>50, "Student > Doctoral Student"=>8, "Student > Ph. D. 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  • {"files"=>["https://ndownloader.figshare.com/files/1586087"], "description"=>"<p>Forest plot of low carbohydrate versus balanced diets in overweight and obese adults with type 2 diabetes for weight loss (kg) at 1–2 years.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "diets", "overweight", "obese", "adults"], "article_id"=>1098187, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.g006", "stats"=>{"downloads"=>2, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_of_low_carbohydrate_versus_balanced_diets_in_overweight_and_obese_adults_with_type_2_diabetes_for_weight_loss_kg_at_1_8211_2_years_/1098187", "title"=>"Forest plot of low carbohydrate versus balanced diets in overweight and obese adults with type 2 diabetes for weight loss (kg) at 1–2 years.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586088"], "description"=>"<p>Search strategies for EMBASE.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "strategies"], "article_id"=>1098188, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t004", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Search_strategies_for_EMBASE_/1098188", "title"=>"Search strategies for EMBASE.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586089"], "description"=>"<p>CVD = cardiovascular disease; No = number; NR = not reported; Rx = treatment; T2DM = type two diabetes mellitus; USA = United States of America; yrs = years.</p><p>Note: In the case of multiple intervention groups, we selected one pair of interventions i.e. treatment and control that was most relevant to this systematic review question.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "included", "randomised", "controlled"], "article_id"=>1098190, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t005", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_included_randomised_controlled_trials_/1098190", "title"=>"Characteristics of included randomised controlled trials.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586093"], "description"=>"<p>CHO = carbohydrate; E = energy; F = females; g = gram; kJ = kilojoule; M = males; MJ = megajoule; N/A = not applicable; No = number; NR = not reported; Rx = treatment; TE = total energy.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "dietary", "goals", "follow-up", "included", "randomised", "controlled"], "article_id"=>1098192, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t006", "stats"=>{"downloads"=>1, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prescribed_dietary_goals_per_length_of_follow_up_for_included_randomised_controlled_trials_/1098192", "title"=>"Prescribed dietary goals per length of follow-up for included randomised controlled trials.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586094"], "description"=>"<p>RCT = randomised controlled trial; CHO = carbohydrate.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "studies", "reasons"], "article_id"=>1098194, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t007", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Excluded_studies_and_reasons_for_exclusion_/1098194", "title"=>"Excluded studies and reasons for exclusion.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586095"], "description"=>"<p>CVD: cardiovascular disease.</p><p>Note: see <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100652#pone.0100652.s002\" target=\"_blank\">Supporting Information S1</a> for the critical summary of existing systematic reviews.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "limitations", "systematic", "reviews", "served", "constraints", "did"], "article_id"=>1098195, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t001", "stats"=>{"downloads"=>3, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Main_limitations_identified_in_existing_systematic_reviews_that_served_as_constraints_to_interpretation_of_the_evidence_and_what_we_did_to_address_them_in_our_review_/1098195", "title"=>"Main limitations identified in existing systematic reviews that served as constraints to interpretation of the evidence and what we did to address them in our review.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586096"], "description"=>"a<p>Energy reduction is implicit as a consequence of extreme restriction of carbohydrates, the reported satiating effect of protein, and appetite suppressing effect of ketones.</p>b<p>Energy reduction is implicit as a consequence of extreme restriction of grains and starches and reported satiating effect of protein.</p>c<p>Portion guides sometimes provided.</p>d<p>Potential risks of inadequacies by extreme restriction of carbohydrates, including most vegetables and fruit.</p>e<p>Potential risks of inadequacies by restricting grains and starches.</p>f<p>Promoted indirectly through recommending a variety of foods from all food groups and quality food choices (including plenty of vegetables and fruit).</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "diets", "compared"], "article_id"=>1098196, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t002", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Low_carbohydrate_CHO_diets_compared_with_a_recommended_balanced_weight_loss_diet_/1098196", "title"=>"Low carbohydrate (CHO) diets compared with a recommended, balanced weight loss diet.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586098"], "description"=>"<p>*Established by drawing on macronutrient recommendations from five global institutions and governments <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100652#pone.0100652-Australian1\" target=\"_blank\">[12]</a>–<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100652#pone.0100652-NNR1\" target=\"_blank\">[15]</a>, <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100652#pone.0100652-Becker1\" target=\"_blank\">[70]</a>.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "macronutrient", "goals"], "article_id"=>1098199, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t003", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cut_off_ranges_used_to_classify_the_macronutrient_goals_of_treatment_and_control_diets_/1098199", "title"=>"Cut-off ranges<sup>*</sup> used to classify the macronutrient goals of treatment and control diets.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586103"], "description"=>"<p>*number of attrition per group given for longest follow-up within the categories;</p><p>BMI = body mass index; BP = blood pressures; COI = conflict of interest; DBP = diastolic blood pressure; HDL = high density lipoprotein cholesterol; ITT = intention-to-treat; LOCF: Last observation carried forward; NB = important; No = number; NR = Not reported; Rx = treatment; TG = triglycerides.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "overweight", "obese"], "article_id"=>1098201, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t008", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_of_bias_in_overweight_and_obese_adult_population_/1098201", "title"=>"Risk of bias in overweight and obese adult population.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586105"], "description"=>"<p>–: not reported; CHO: carbohydrate; f: females, m: males; kJ: kilojoules; NA: not applicable; SD: standard deviation</p>a<p>Arbitrary adherence score, calculated using a Mahalanobis distance equation, represents the degree of deviation from the prescribed goals for macronutrients in the two diet groups. A lower score reflects better adherence and a higher score reflects poorer adherence.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "comparisons", "intakes", "calculated", "adherence", "scores", "lengths"], "article_id"=>1098203, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t009", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Group_comparisons_of_mean_reported_energy_intakes_and_calculated_adherence_scores_per_diet_group_for_all_lengths_of_follow_up_/1098203", "title"=>"Group comparisons of mean reported energy intakes and calculated adherence scores per diet group for all lengths of follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586106"], "description"=>"<p><b>CI:</b> Confidence interval;</p>a<p>Note this is the univariate average change observed between follow-up and baseline in the control group.</p><p>GRADE Working Group grades of evidence.</p><p>High quality: Further research is very unlikely to change our confidence in the estimate of effect.</p><p>Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.</p><p>Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.</p><p>Very low quality: We are very uncertain about the estimate.</p>1<p>Downgraded by 1 for risk of bias: 1 of 5 studies did not report adequate sequence generation and 3 of 5 studies did not report adequate allocation concealment. 1 study had high total attrition (>20%) and 2 studies had differential attrition.</p>2<p>Downgraded by 1 for imprecision: difference in mean weight loss ranges from a loss of 1.25 to a gain of 2.9 kilograms.</p>3<p>Downgraded by 1 for risk of bias: 1 out of 5 studies did not report adequate sequence generation and 3 out of 5 studies did not report allocation concealment. 1 study had high total attrition and 2 studies had differential attrition.</p>4<p>Downgraded by 1 for risk of bias: 2 of 4 studies did not report adequate allocation concealment. 1 study had high total attrition (>20%) and 2 studies had differential attrition.</p>5<p>Downgraded by 1 for imprecision: difference in mean systolic blood pressure ranges from a reduction of 3.14 to an increase of 4.36 mmHg.</p>6<p>Downgraded for risk of bias: 1 of 4 studies did not report adequate sequence generation and 2 studies did not report adequate allocation concealment. 2 studies had differential attrition.</p>7<p>Downgraded by 1 for imprecision: confidence interval range is 0.5 mmol/L.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "findings", "diets", "compared", "overweight", "obese", "adults", "mellitus", "months"], "article_id"=>1098204, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t012", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_findings_for_low_carbohydrate_diets_compared_with_balanced_diets_for_overweight_and_obese_adults_with_type_2_diabetes_mellitus_at_3_8211_6_months_follow_up_/1098204", "title"=>"Summary of findings for low carbohydrate diets compared with balanced diets for overweight and obese adults with type 2 diabetes mellitus at 3–6 months follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586107"], "description"=>"<p>CI: Confidence interval;</p>a<p>Note this is the univariate average change observed between follow-up and baseline in the control group.</p><p>GRADE Working Group grades of evidence.</p><p>High quality: Further research is very unlikely to change our confidence in the estimate of effect.</p><p>Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.</p><p>Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.</p><p>Very low quality: We are very uncertain about the estimate.</p>1<p>Downgraded by 1 for risk of bias: 5 of 7 studies did not report adequate sequence generation and only 1 reported adequate allocation concealment. 5 studies were judged to have a high or unclear risk of attrition bias.</p>2<p>Downgraded by 1 for risk of bias: the study did not report adequate allocation concealment and reasons for attrition differed between groups.</p>3<p>Downgraded by 1 for imprecision: difference in mean BMI change ranges from a reduction of −0.94 to an increase of 0.14 kg/m<sup>2</sup> (approximately equivalent to 2 to 4 kilograms).</p>4<p>Downgraded by 1 for risk of bias: 4 of 6 studies did not report adequate sequence generation and 5 studies did not report adequate allocation concealment. 2 studies had high total attrition (>20%), 1 of which also had differential attrition.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "findings", "diets", "compared", "overweight", "obese", "adults", "years"], "article_id"=>1098205, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t011", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_findings_for_low_carbohydrate_diets_compared_with_balanced_diets_for_overweight_and_obese_adults_at_1_8211_2_years_follow_up_/1098205", "title"=>"Summary of findings for low carbohydrate diets compared with balanced diets for overweight and obese adults at 1–2 years follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586108"], "description"=>"<p>CI: Confidence interval ;</p>a<p>Note this is the univariate average change observed between follow-up and baseline in the control group.</p><p>GRADE Working Group grades of evidence.</p><p>High quality: Further research is very unlikely to change our confidence in the estimate of effect.</p><p>Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.</p><p>Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.</p><p>Very low quality: We are very uncertain about the estimate.</p>1<p>Downgraded by 1 for risk of bias: 8 of 14 studies did not report adequate sequence generation and 13 studies did not report adequate allocation concealment. 4 studies had high total attrition (>20%) and 2 other studies had differential attrition.</p>2<p>Not downgraded for inconsistency: no qualitative heterogeneity; some quantitative heterogeneity, to be expected.</p>3<p>Downgraded by 1 for risk of bias: 1 study did not report adequate sequence generation, none of the studies reported on allocation concealment and 1 study had high total attrition (>20%).</p>4<p>Downgraded by 1 for risk of bias: 5 of 8 studies did not report adequate sequence generation and 7 studies did not report adequate allocation concealment. 2 studies had high total attrition (>20%).</p>5<p>Downgraded by 1 for inconsistency: Mean differences were on opposite sides of the line of no difference (I<sup>2</sup> 51%).</p>6<p>Downgraded by 1 for risk of bias: 5 of 8 studies did not report adequate sequence generation and 7 studies did not report adequate allocation concealment. 2 studies had high total attrition (>20%).</p>7<p>Downgraded by 1 for risk of bias: 5 of 12 studies did not report adequate sequence generation and 11 studies did not report adequate allocation concealment. 3 studies had high total attrition (>20%) and 2 other studies had differential attrition.</p>8<p>Downgraded by 1 for risk of bias: 6 of 12 studies did not report adequate sequence generation and 11 studies did not report adequate allocation concealment. 3 studies had high total attrition (>20%) and 2 studies had differential attrition.</p>9<p>Downgraded by 1 for inconsistency: Mean differences were on opposite sides of the line of no difference (I<sup>2</sup> 63%).</p>10<p>Downgraded by 1 for risk of bias: 6 of 12 studies did not report adequate sequence generation and 11 studies did not report adequate allocation concealment. 3 studies had had total attrition (>20%) and 2 studies had differential attrition.</p>11<p>Downgraded by 1 for inconsistency: Mean differences were on opposite sides of the line of no difference (I<sup>2</sup> 72%).</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "findings", "diets", "compared", "overweight", "obese", "months"], "article_id"=>1098206, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t010", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_findings_for_meta_analysis_of_low_carbohydrate_diets_compared_with_balanced_diets_for_overweight_and_obese_adults_3_8211_6_months_follow_up_/1098206", "title"=>"Summary of findings for meta-analysis of low carbohydrate diets compared with balanced diets for overweight and obese adults: 3–6 months follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586109"], "description"=>"<p>CI: Confidence interval;</p>a<p>Note this is the univariate average change observed between follow-up and baseline in the control group.</p><p>GRADE Working Group grades of evidence.</p><p>High quality: Further research is very unlikely to change our confidence in the estimate of effect.</p><p>Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.</p><p>Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.</p><p>Very low quality: We are very uncertain about the estimate.</p>1<p>Downgraded by 1 for risk of bias: 2 of 4 studies did not report adequate allocation concealment. 1 study had high total attrition (>20%) and 2 studies had differential attrition.</p>2<p>Downgraded by 1 for imprecision: The 95% confidence interval includes both a loss of 2.08 kg and a gain of 3.89 kg.</p>3<p>Downgraded by 1 for risk of bias: 2 of 4 studies did not report adequate allocation concealment, 2 studies had high total attrition (>20%), 2 studies had differential attrition.</p>4<p>Downgraded by 1 for risk of bias: 1 of 3 studies did not report adequate allocation concealment. 2 studies had high total attrition (>20%), 2 studies had differential attrition.</p>5<p>Downgraded by 1 for imprecision: confidence interval range is about 0.7 mmol/L.</p>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "findings", "diets", "compared", "overweight", "obese", "adults", "mellitus", "years"], "article_id"=>1098208, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0100652.t013", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_findings_for_low_carbohydrate_diets_compared_with_balanced_diets_for_overweight_and_obese_adults_with_type_2_diabetes_mellitus_at_1_8211_2_years_follow_up_/1098208", "title"=>"Summary of findings for low carbohydrate diets compared with balanced diets for overweight and obese adults with type 2 diabetes mellitus at 1–2 years follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-07-09 03:08:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1586156", "https://ndownloader.figshare.com/files/1586157", "https://ndownloader.figshare.com/files/1586158", "https://ndownloader.figshare.com/files/1586160"], "description"=>"<div><p>Background</p><p>Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets.</p><p>Methods and Findings</p><p>We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3–6 months and 1–2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects meta-analysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3–6 months (MD 0.74 kg, 95%CI −1.49 to 0.01 kg; I<sup>2</sup> = 53%; n = 1745, 14 trials; moderate quality evidence) and 1–2 years (MD 0.48 kg, 95%CI −1.44 kg to 0.49 kg; I<sup>2</sup> = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3–6 months and 1–2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (>914 participants). In diabetic participants, findings showed a similar pattern.</p><p>Conclusions</p><p>Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.</p></div>", "links"=>[], "tags"=>["nutrition", "Clinical medicine", "clinical trials", "cardiology", "mathematics", "Statistics (mathematics)", "Statistical methods", "meta-analysis", "Research assessment", "Systematic reviews", "isoenergetic", "diets", "reducing", "cardiovascular", "systematic"], "article_id"=>1098248, "categories"=>["Biological Sciences"], "users"=>["Celeste E. Naude", "Anel Schoonees", "Marjanne Senekal", "Taryn Young", "Paul Garner", "Jimmy Volmink"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0100652.s001", "https://dx.doi.org/10.1371/journal.pone.0100652.s002", "https://dx.doi.org/10.1371/journal.pone.0100652.s003", "https://dx.doi.org/10.1371/journal.pone.0100652.s004"], "stats"=>{"downloads"=>19, "page_views"=>26, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Low_Carbohydrate_versus_Isoenergetic_Balanced_Diets_for_Reducing_Weight_and_Cardiovascular_Risk_A_Systematic_Review_and_Meta_Analysis_/1098248", "title"=>"Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-07-09 03:08:39"}

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Relative Metric

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