A clinical trial published in Cell Metabolism found that adults with obesity, prediabetes, and fatty liver disease who followed a ketogenic diet achieved substantially greater reductions in liver fat than those who followed a Mediterranean or low-fat plant-based diet, despite similar weight loss across all three groups. The findings suggest that dietary composition influences metabolic outcomes independently of weight reduction.
The trial enrolled 55 adults with obesity, prediabetes, and hepatic steatosis, with 42 participants included in the final analysis. Each group followed a distinct dietary pattern: the ketogenic diet provided approximately 4% of calories from carbohydrates and 73% from fat; the Mediterranean diet provided around 50% from carbohydrates and 35% from fat; and the plant-forward diet provided approximately 70% from carbohydrates and 15% from fat. Researchers adjusted calorie intake for each group to target approximately 10% weight loss, allowing them to compare metabolic effects independently of differences in weight reduction.
Liver fat fell by an average of 67% in the ketogenic group, compared with approximately 45% in the Mediterranean and plant-based groups. The ketogenic group also demonstrated two to three times greater improvement in hepatic insulin sensitivity. Average 24-hour blood glucose levels fell by approximately 20% in the ketogenic group versus around 8% in the other two groups. By the end of the four to five month intervention, approximately half of ketogenic diet participants no longer met the criteria for prediabetes, compared with 29% of Mediterranean diet participants and 7% of plant-based diet participants.
The researchers propose that very low carbohydrate intake may shift the body towards fat utilisation and increase glucagon activity, contributing to a greater reduction in liver fat. The authors caution that the study was small, highly controlled, and of short duration, limiting the applicability of the findings to broader populations or long-term outcomes.
Source: Carter L. Keto Cut Liver Fat By 67% Despite Similar Weight Loss With Mediterranean And Low-Fat Plant-Based Diets.
