{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:12:03Z","timestamp":1790313123800,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T00:00:00Z","timestamp":1725840000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,27]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The ketogenic diet is a very low carbohydrate diet known for its ability to reduce weight and counteract hyperglycaemia. However, ketogenic diets recommend an increased intake of fats, raising concerns about cardiometabolic risk in adults. Due to the higher intake of fats in the ketogenic diet, there is significant variability in outcomes of lipid metabolism in the population. Interventions have reported improvements in lipid profile while other studies did not find changes, and there are reports of increased low density lipoprotein (LDL) and triglyceride values. Hence, this is a protocol for a systematic review of the published literature and a summary of the effect of ketogenic diets on lipid metabolism in adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Five databases (PubMed, Embase, Scopus, Cochrane Library and Web of Science) will be searched for studies on ketogenic diets in adult populations. Studies will be included if they report results from ketogenic diet interventions among adults. Exclusion is populations with diagnosed neurological disorders. Two reviewers will independently screen retrieved citations, extract data and appraise the risk of bias. Quantitative estimates (eg, standardised mean difference) measuring the change in the total cholesterol, LDL and triglyceride concentration will be pooled using random effects meta-analysis to produce one summarised weighted estimate. Sources of heterogeneity will be explored using subgroup analysis. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols (PRISMA), and the final review will be reported following the PRISMA 2020 guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The present protocol and the systematic review to be carried out do not require ethics clearance. The data source will be published studies. This review will provide estimates to inform the public about the effect of ketogenic diets on lipid metabolism and the possible peril of increasing cardiometabolic risk. The results will be published in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42022309665.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076938","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T01:50:30Z","timestamp":1726019430000},"page":"e076938","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of ketogenic diets on lipid metabolism in adults: protocol for a systematic review"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0441-7391","authenticated-orcid":false,"given":"Serene","family":"Hilary","sequence":"first","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5091-604X","authenticated-orcid":false,"given":"Linda","family":"\u00d6stlundh","sequence":"additional","affiliation":[{"name":"\u00d6rebro University Library, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carine","family":"Platat","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-0353","authenticated-orcid":false,"given":"Rami H","family":"Al-Rifai","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osha","family":"Almehairbi","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayeza","family":"Alshamsi","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habiba I","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha S","family":"Al Dhaheri","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Cheikh Ismail","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE"},{"name":"Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily","family":"Stojanovska","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE"},{"name":"Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"2025121422365680000_14.9.e076938.1","unstructured":"WHO . Controlling the global obesity epidemic Geneva: World Health Organization, 2021. Available: https:\/\/www.who.int\/activities\/controlling-the-global-obesity-epidemic"},{"key":"2025121422365680000_14.9.e076938.2","unstructured":"WHO . Obesity and overweight Geneva: world health organization. 2021. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight"},{"key":"2025121422365680000_14.9.e076938.3","doi-asserted-by":"crossref","unstructured":"Franco S , Barbanera M , Moscetti R , et al . Overnutrition is a significant component of food waste and has a large environmental impact. Sci Rep 2022;12. doi:10.1038\/s41598-022-11813-5","DOI":"10.1038\/s41598-022-11813-5"},{"key":"2025121422365680000_14.9.e076938.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13098-020-00570-y","article-title":"NAFLD as a continuum: from obesity to metabolic syndrome and diabetes","volume":"12","author":"Godoy-Matos","year":"2020","journal-title":"Diabetol Metab Syndr"},{"key":"2025121422365680000_14.9.e076938.5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.gtc.2019.09.003","article-title":"Nutrition and Nonalcoholic fatty liver disease: Current perspectives","volume":"49","author":"Chakravarthy","year":"2020","journal-title":"Gastroenterol Clin North Am"},{"key":"2025121422365680000_14.9.e076938.6","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/978-981-10-8684-7_12","article-title":"Current prevention and treatment options for NAFLD","volume":"1061","author":"Wong","year":"2018","journal-title":"Adv Exp Med Biol"},{"key":"2025121422365680000_14.9.e076938.7","doi-asserted-by":"crossref","unstructured":"Zhu H , Bi D , Zhang Y , et al . Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical Implementations. Signal Transduct Target Ther 2022;7. doi:10.1038\/s41392-021-00831-w","DOI":"10.1038\/s41392-021-00831-w"},{"key":"2025121422365680000_14.9.e076938.8","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1001\/jamainternmed.2019.2633","article-title":"The Ketogenic diet for obesity and diabetes\u2014enthusiasm Outpaces evidence","volume":"179","author":"Joshi","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2025121422365680000_14.9.e076938.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2019.08.003"},{"key":"2025121422365680000_14.9.e076938.10","doi-asserted-by":"crossref","unstructured":"Ebbeling CB , Feldman HA , Klein GL , et al . Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ 2018;363. doi:10.1136\/bmj.k4583","DOI":"10.1136\/bmj.k4583"},{"key":"2025121422365680000_14.9.e076938.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.6607"},{"key":"2025121422365680000_14.9.e076938.12","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/ajcn\/87.1.44","article-title":"Effects of a high-protein Ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum","volume":"87","author":"Johnstone","year":"2008","journal-title":"Am J Clin Nutr"},{"key":"2025121422365680000_14.9.e076938.13","unstructured":"Oh R , Gilani B , Uppaluri KR . Low Carbohydrate Diet: StatPearls Publishing. Treasure Island (FL), 2022."},{"key":"2025121422365680000_14.9.e076938.14","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s12986-016-0132-8","article-title":"A low-carbohydrate high-fat diet decreases lean mass and impairs cardiac function in pair-Fed female C57Bl\/6J mice","volume":"13","author":"Nilsson","year":"2016","journal-title":"Nutr Metab (Lond)"},{"key":"2025121422365680000_14.9.e076938.15","doi-asserted-by":"crossref","unstructured":"Nakao R , Abe T , Yamamoto S , et al . Ketogenic diet induces Skeletal muscle atrophy via reducing muscle protein synthesis and possibly activating proteolysis in mice. Sci Rep 2019;9. doi:10.1038\/s41598-019-56166-8","DOI":"10.1038\/s41598-019-56166-8"},{"key":"2025121422365680000_14.9.e076938.16","doi-asserted-by":"publisher","DOI":"10.1210\/en.2010-0175"},{"key":"2025121422365680000_14.9.e076938.17","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00453.2013"},{"key":"2025121422365680000_14.9.e076938.18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jacl.2020.10.005","article-title":"Ketogenic diets, not for everyone","volume":"15","author":"Goldberg","year":"2021","journal-title":"J Clin Lipidol"},{"key":"2025121422365680000_14.9.e076938.19","article-title":"Significant impact of the Ketogenic diet on low-density lipoprotein cholesterol levels","volume":"12","author":"Salas Noain","year":"2020","journal-title":"Cureus"},{"key":"2025121422365680000_14.9.e076938.20","doi-asserted-by":"crossref","unstructured":"Muscogiuri G , Barrea L , Laudisio D , et al . The management of very low-calorie Ketogenic diet in obesity outpatient clinic: a practical guide. J Transl Med 2019;17. doi:10.1186\/s12967-019-2104-z","DOI":"10.1186\/s12967-019-2104-z"},{"key":"2025121422365680000_14.9.e076938.21","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-10-200405180-00007"},{"key":"2025121422365680000_14.9.e076938.22","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1017\/S0007114521002609","article-title":"Ketogenic diets, physical activity and body composition: a review","volume":"127","author":"Ashtary-Larky","year":"2022","journal-title":"Br J Nutr"},{"key":"2025121422365680000_14.9.e076938.23","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/132.7.1879"},{"key":"2025121422365680000_14.9.e076938.24","doi-asserted-by":"crossref","unstructured":"Zhou C , Wang M , Liang J , et al . 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 trails. Int J Environ Res Public Health 2022;19. doi:10.3390\/ijerph191610429","DOI":"10.3390\/ijerph191610429"},{"key":"2025121422365680000_14.9.e076938.25","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.pediatrneurol.2015.10.017","article-title":"The effect of the Ketogenic diet on the vascular structure and functions in children with intractable epilepsy","volume":"56","author":"\u00d6zdemir","year":"2016","journal-title":"Pediatr Neurol"},{"key":"2025121422365680000_14.9.e076938.26","doi-asserted-by":"crossref","unstructured":"Bur\u00e9n J , Ericsson M , Damasceno NRT , et al . A Ketogenic low-carbohydrate high-fat diet increases LDL cholesterol in healthy, young, normal-weight women: A randomized controlled feeding trial. Nutrients 2021;13. doi:10.3390\/nu13030814","DOI":"10.3390\/nu13030814"},{"key":"2025121422365680000_14.9.e076938.27","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s13760-016-0601-x","article-title":"The effects of classic Ketogenic diet on serum lipid profile in children with refractory seizures","volume":"116","author":"Zamani","year":"2016","journal-title":"Acta Neurol Belg"},{"key":"2025121422365680000_14.9.e076938.28","doi-asserted-by":"crossref","unstructured":"Moher D , Shamseer L , Clarke M , et al . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4. doi:10.1186\/2046-4053-4-1","DOI":"10.1186\/2046-4053-4-1"},{"key":"2025121422365680000_14.9.e076938.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and Exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025121422365680000_14.9.e076938.30","unstructured":"Cabell\u2019s predatory report: Cabell\u2019s scholarly Analytics. 2023. Available: https:\/\/cabells.com\/solutions\/predatory-reports"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-076938","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:37:05Z","timestamp":1765780625000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-076938"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,10]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/bmjopen-2023-076938"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-076938","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}