Endocr Pract. 2026 Jan 30:S1530-891X(26)00026-1. doi: 10.1016/j.eprac.2026.01.009. Online ahead of print.

ABSTRACT

OBJECTIVES: The impact of the ketogenic diet (KD) on lipid metabolism remains inconclusive. To address this gap, we conducted a meta-regression analysis of randomized controlled trials (RCTs) to evaluate the overall influence of KD on lipid profile parameters in adults.

METHODS: A comprehensive search of five major electronic databases was carried out using predefined keywords to identify RCTs assessing the effects of KD on lipid outcomes. Pooled weighted mean differences with 95% confidence intervals were calculated employing a random-effects model.

RESULTS: Sixty-two studies were analyzed. The meta-analysis results from the included randomized controlled trials indicated a significant decrease in triglyceride (TG) levels (WMD: -19.96 mg/dl, 95% CI: -26.10 to -13.81) and the TG/high-density lipoprotein-cholesterol (HDL-C) ratio (WMD: -0.31, 95% CI: -0.49 to -0.12), despite a notable increase in HDL-C (WMD: 3.61 mg/dl, 95% CI: 1.44 to 5.57), low-density lipoprotein-cholesterol (LDL-C) (WMD: 8.49 mg/dl, 95% CI: 5.45 to 11.52), and total cholesterol (TC) (WMD: 8.14 mg/dl, 95% CI: 3.41 to 12.88) concentrations following KD compared to the control group. However, LDL-C levels increased by 8.49 mg/dL, which may carry potential adverse implications.Furthermore, the findings indicated a linear correlation between alterations in HDL-C and the duration of KD intervention.

CONCLUSIONS: The ketogenic diet significantly improves triglycerides and HDL-C but also leads to modest increases in LDL-C. Given the lack of long-term cardiovascular outcome data, these findings should be interpreted with caution.

PMID:41621647 | DOI:10.1016/j.eprac.2026.01.009

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