{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:57:54Z","timestamp":1785589074575,"version":"3.56.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["101017424"],"award-info":[{"award-number":["101017424"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Cardiac rehabilitation (CR) is integral to secondary prevention in coronary artery disease (CAD), incorporating exercise, medical optimization, and dietary interventions. While low-carbohydrate (low-carb) and low-fat diets may improve metabolic health, their comparative impact on cardiovascular risk in CR remains unclear. This study assessed the effects of low-carb and low-fat diets on cardiovascular risk, body composition, and major adverse cardiovascular and cerebrovascular events (MACCE) in CAD patients undergoing inpatient CR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this quasi-experimental study, 313 CAD patients (56\u202f\u00b1\u202f7\u202fyears, 20% women) participated in CR, adopting a low-carb (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f58), low-fat (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f136), or regular diet (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f119, control). Dietary assignment was non-randomized and based on assisted patient self-selection. A biomarker-based score to estimate the 10-year cardiovascular mortality risk, bioelectrical impedance analysis, and laboratory parameters (HbA1c, lipids, inflammation markers) were assessed at baseline, discharge, and 6-month follow-up. Kaplan\u2013Meier analysis was used to compare MACCE recorded for a mean of 470\u202f\u00b1\u202f293\u202fdays.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During 3\u20134\u202fweeks of CR, the 10-year cardiovascular mortality risk decreased by a mean of 3.7\u202f\u00b1\u202f9.6%, with no difference between dietary groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.8651). HbA1c improved in the low-carb group during CR compared to the low-fat and regular diet (\u22124.0\u202f\u00b1\u202f6.6%), but the effect was not significant after adjustments for baseline HbA1c, diabetes prevalence, and medication (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.168). Reductions in BMI, body fat, and visceral fat were recorded in the low-carb and low-fat group, compared to the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2264\u202f0.0001). Total cholesterol, LDL, and triglyceride levels also decreased in all groups during CR without significant differences (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2265\u202f0.3957). MACCE incidence did not differ between the groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No additional immediate benefit in risk reduction during CR for low-carb or low-fat dietary interventions was detected. However, the low-fat and low-carb diet resulted in significantly greater reductions in BMI, body fat and visceral fat, with a tendency towards more stable effects over 6\u202fmonths in the low-fat group. While glycemic control was improved in the low-carb group during inpatient CR, long-term adherence appeared challenging, particularly for diabetic patients as HbA1c levels re-increased during 6\u202fmonths follow-up. Since no difference in MACCE was seen, the dietary interventions may be considered equally safe for CAD patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1669931","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T14:19:56Z","timestamp":1761229196000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomarker-based risk assessment of dietary intervention in patients with coronary artery disease during cardiac rehabilitation\u2014a quasi-experimental 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2017 using the global burden of disease study and implications for prevention","volume":"9","author":"Li","year":"2021","journal-title":"Front Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12872-024-03838-7","article-title":"Investigating the interplay of smoking, cardiovascular risk factors, and overall cardiovascular disease risk: NHANES analysis 2011\u20132018","volume":"24","author":"Mambo","year":"2024","journal-title":"BMC Cardiovasc 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