Am J Clin Nutr. 2026 Jan 27:101211. doi: 10.1016/j.ajcnut.2026.101211. Online ahead of print.

ABSTRACT

BACKGROUND: Health-related quality of life (HRQoL) is a central aspect of overall health and a crucial factor in dietary interventions, as it may determine both dietary compliance and sustained adherence.

OBJECTIVE: We assessed the effect on HRQoL between: 1) the Low-Carbohydrate High-Fat (LCHF) diet and 2) the High-Carbohydrate Low-Fat (HCLF) diet and evaluated the impact on dietary compliance and sustained adherence.

METHODS: This is a prespecified secondary analysis from a randomized controlled trial in people with type 2 diabetes. Participants were randomized 2:1 to follow either LCHF or HCLF for six months with a post-intervention visit nine months after inclusion. Liver biopsies were performed at baseline and after six months, the Diabetes-39 HRQoL questionnaire, standard clinical and compliance assessments were conducted at baseline, three months, six months and nine months (post-intervention), sustained adherence was assessed at the post-intervention visit.

RESULTS: We randomized 165 participants, 96 (58%) were female. At baseline, the median age was 56 (IQR, 50-63) years, mean BMI was 33+7 kg/m2, total median HRQoL score was 88 (IQR, 70-111), mean hemoglobin A1c (HbA1c) was 56+10 mmol/mol and 141 (88%) had metabolic dysfunction-associated steatotic liver disease (MASLD). After six months intervention, HRQoL improved in both groups (LCHF: -14.5; (95% CI: -20.7,-8.36); p<0.001; HCLF; -13.7; (95%CI: -22.7,-4.6); p=0.003) with no mean difference in change between groups (Δ) p=0.855. Higher improvements in HRQoL were associated with a higher compliance with the diets (Spearman’s rho; -0.183; p=0.0378) and increased the likelihood of sustained adherence to the LCHF diet.

CONCLUSION: HRQoL improved in both dietary intervention groups with no difference between groups. Dietary compliance was associated with improved HRQoL and may play a role in sustained adherence to the LCHF diet.

CLINICAL TRIAL REGISTRY NUMBER: ClinicalTrials.gov (NCT03068078), https://clinicaltrials.gov/study/NCT03068078.

PMID:41611090 | DOI:10.1016/j.ajcnut.2026.101211

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