The Effect of the Ketogenic Diet on Weight Loss and Metabolic Risk Factors: A Systematic Review and Meta-Analysis

Authors

  • Intan Lestari Putri Universitas Udayana, Indonesia
  • I Wayan Weta Universitas Udayana, Indonesia

DOI:

https://doi.org/10.46799/jhs.v6i10.2708

Keywords:

Weight loss, diet, ketogenic, metabolic, obesity

Abstract

Obesity remains a major global health problem with increasing prevalence, leading to a rise in the use of dietary interventions such as the ketogenic diet. Despite its popularity, evidence regarding its effectiveness in improving metabolic parameters remains inconsistent. This study aimed to evaluate the impact of the ketogenic diet on weight loss and metabolic risk factors through a systematic review and meta-analysis. Following the PRISMA 2020 guidelines, relevant studies were retrieved from PubMed, ScienceDirect, Cochrane Library, and ProQuest databases. Eligible randomized controlled trials assessing the effects of the ketogenic diet on glucose control, blood pressure, body mass index (BMI), and lipid profiles in obese patients were included. Data extraction and quality assessment were conducted using the Risk of Bias (RoB) tool, and statistical analyses were performed with Review Manager v5.3. Nine eligible studies (n = 437 participants) were included. The ketogenic diet significantly reduced blood glucose levels (SMD = -0.27 mg/dL, 95% CI: -0.50 to -0.04, P = 0.02) and triglycerides (SMD = -28.38 mg/dL, 95% CI: -32.07 to -24.69, P < 0.001), while increasing LDL cholesterol (SMD = 17.27 mg/dL, 95% CI: 1.10 to 33.44, P = 0.04). However, no significant changes were observed in BMI, HDL, total cholesterol, or blood pressure. Funnel plot and Egger’s test results indicated no publication bias. In conclusion, the ketogenic diet demonstrates beneficial effects on glucose regulation and triglyceride reduction but has limited efficacy for weight loss and may elevate LDL levels, warranting cautious clinical application in obesity management.

References

Charlot, A., & Zoll, J. (2022). Beneficial Effects of the Ketogenic Diet in Metabolic Syndrome: A Systematic Review. Diabetology, 3(2), 292–309.

Di Cesare, M., Sorić, M., Bovet, P., Miranda, J. J., Bhutta, Z., Stevens, G. A., et al. (2019). La carga epidemiológica de la obesidad infantil: Una epidemia mundial que requiere medidas urgentes. BMC Medicine, 17(1), 1–20. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1449-8

Gershuni, V. M., Yan, S. L., & Medici, V. (2018). Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Current Nutrition Reports, 7(3), 97–106.

Hall, K. D., Guo, J., Courville, A. B., Boring, J., Brychta, R., Chen, K. Y., et al. (2021). Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake. Nature Medicine, 27(2), 344–353. http://dx.doi.org/10.1038/s41591-020-01209-1

Hwalla, N., & Jaafar, Z. (2021). Dietary management of obesity: A review of the evidence. Diagnostics, 11(1).

Kerkadi, A., Sadig, A. H., Bawadi, H., Thani, A. A. M. Al, Chetachi, W. Al, Akram, H., et al. (2019). The relationship between lifestyle factors and obesity indices among adolescents in Qatar. International Journal of Environmental Research and Public Health, 16(22), 1–15.

Li, J., Bai, W. P., Jiang, B., Bai, L. R., Gu, B., Yan, S. X., et al. (2021). Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open-label, parallel-group, controlled pilot trial. Journal of Obstetrics and Gynaecology Research, 47(3), 1145–1152.

Li, S., Lin, G., Chen, J., Chen, Z., Xu, F., Zhu, F., et al. (2022). The effect of periodic ketogenic diet on newly diagnosed overweight or obese patients with type 2 diabetes. BMC Endocrine Disorders, 22(1), 4–9. https://doi.org/10.1186/s12902-022-00947-2

Li, S., Yuan, S., Lin, G., & Zhang, J. (2023). Study. Medicine (Baltimore), 102(43), e35753. http://www.ncbi.nlm.nih.gov/pubmed/37904380

Moriconi, E., Camajani, E., Fabbri, A., Lenzi, A., & Caprio, M. (2020). Very-low-calorie ketogenic diet as a safe and valuable tool for long-term glycemic management in patients with obesity and type 2 diabetes. Nutrients, 13(3), 1–15.

Sánchez, E., Santos, M. D., Nuñez-Garcia, M., Bueno, M., Sajoux, I., Yeramian, A., et al. (2022). Randomized clinical trial to evaluate the morphological changes in the adventitial vasa vasorum density and biological markers of endothelial dysfunction in subjects with moderate obesity undergoing a very low-calorie ketogenic diet. Nutrients, 14(1).

Saslow, L. R., Jones, L. M., Sen, A., Wolfson, J. A., Diez, H. L., O’Brien, A., et al. (2023). Comparing very low-carbohydrate vs DASH diets for overweight or obese adults with hypertension and prediabetes or type 2 diabetes: A randomized trial. Annals of Family Medicine, 21(3), 256–263.

Schiavo, L., Pierro, R., Asteria, C., Calabrese, P., Di Biasio, A., Coluzzi, I., et al. (2022). Low-Calorie Ketogenic Diet with Continuous Positive Airway Pressure to Alleviate Severe Obstructive Sleep Apnea Syndrome in Patients with Obesity Scheduled for Bariatric/Metabolic Surgery: A Pilot, Prospective, Randomized Multicenter Comparative Study. Obesity Surgery, 32(3), 634–642. https://doi.org/10.1007/s11695-021-05811-1

Stanciu, S., Rusu, E., Miricescu, D., Radu, A. C., Axinia, B., Vrabie, A. M., et al. (2023). Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs. Metabolites, 13(1), 1–22.

Sun, S., Kong, Z., Shi, Q., Hu, M., Zhang, H., Zhang, D., et al. (2019). Non-Energy-Restricted Low-Carbohydrate Diet Combined with Exercise Intervention Improved Cardiometabolic Health in Overweight Chinese Females. Nutrients, 11(12).

World Health Organization (WHO). (2024). Obesity.

Zhang, W., Guo, X., Chen, L., Chen, T., Yu, J., Wu, C., et al. (2021). Ketogenic Diets and Cardio-Metabolic Diseases. Frontiers in Endocrinology (Lausanne), 12(November), 1–11.

Zhou, C., Wang, M., Liang, J., He, G., & Chen, N. (2022). Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. International Journal of Environmental Research and Public Health, 19(16).

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Published

2025-10-28

Issue

Vol. 6 No. 10 (2025): Journal Health Sains

Section

Articles

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