The influence of diet macronutrient content on the cardiometabolic effects of weight loss in people with metabolically unhealthy obesity (prediabetes and hepatic steatosis) has important clinical implications. We evaluated the cardiometabolic effects of moderate (∼10%) weight loss induced by three popular diets with markedly different macronutrient composition (very-low-carbohydrate ketogenic, Mediterranean, and very-low-fat plant-forward). Weight loss increased muscle insulin sensitivity by ∼50% in all groups but caused a two-to-three-fold greater increase in hepatic insulin sensitivity in the very-low-carbohydrate group than the other groups (p < 0.001). Intrahepatic triglyceride content, hepatic de novo lipogenesis, glycated hemoglobin, and 24-h serial plasma glucose and insulin decreased most in the very-low-carbohydrate group. There were no differences among groups in LDL-cholesterol, apolipoprotein B, or 24-h plasma triglyceride concentrations. These results demonstrate that a very-low-carbohydrate diet has greater cardiometabolic benefits, particularly in hepatic metabolic function, than matched 10% weight loss induced by a Mediterranean or very-low-fat diet in people with metabolically unhealthy obesity. This study was registered at ClinicalTrials.gov (NCT02706262).
Full Paper - https://doi.org/10.1016/j.cmet.2026.07.020
TLDR: Keto more effective in reducing live fat after 10% weight loss vs low fat plant based, and mediterranean. Keto 700% as effective at reducing blood glucose levels.
about 6 months for each diet intervention, long enough to actually adapt, they measured ketones, but only once during a 24 hour period at base and at 10% weight loss, with ketone levels 0.4-0.7 mmol/L... so very mild ketosis
ooph the paper reaffirms CICO in the introduction
why isn't that the headline? keto 700% as effective as a plant forward diet in reversing prediabetes
ha! they fixed the study, its only obese people, so they wont have any LMHRs by definition... not sure if it was intentional or not, but the fact LDL didn't rise in obese people isn't a surprise, and I'm not sure it would help the naysayers back off
its a great paper with really solid data collected, it's worth reading and evaluating in depth.