Health-related quality of life, compliance and sustained adherence on a low-carbohydrate high-fat diet compared with a high-carbohydrate low-fat diet in people with type 2 diabetes.

BACKGROUND

Health-related quality of life (HRQoL) is a central aspect of overall health and a crucial factor in dietary interventions, as it may determine both dietary compliance and sustained adherence.

OBJECTIVES

We assessed the effect on HRQoL between: 1) the low-carbohydrate high-fat (LCHF) diet and 2) the high-carbohydrate low-fat (HCLF) diet and evaluated the impact on dietary compliance and sustained adherence.

METHODS

This is a prespecified secondary analysis from a randomized controlled trial in people with type 2 diabetes. Participants were randomly assigned 2:1 to follow either LCHF or HCLF for 6 mo with a postintervention visit 9 mo after inclusion. Liver biopsies were performed at baseline and after 6 mo, the Diabetes-39 HRQoL questionnaire, standard clinical and compliance assessments were conducted at baseline, 3 mo, 6 mo, and 9 mo (postintervention). Sustained adherence was assessed at the postintervention visit.

RESULTS

We randomly assigned 165 participants; 96 (58%) were female. At baseline, the median age was 56 [interquartile range (IQR) 50-63] y, mean body mass index was 33 + 7 kg/m2, total median HRQoL score was 88 (IQR, 70-111), mean hemoglobin A1c was 56+10 mmol/mol, and 141 (88%) had metabolic dysfunction-associated steatotic liver disease. After 6-mo intervention, HRQoL improved in both groups {LCHF: -14.5 [95% confidence interval (CI): -20.7, -8.36]; P < 0.001; HCLF; -13.7 (95% CI: -22.7, -4.6); P = 0.003} with no mean difference in change between groups (Δ) P = 0.855. Higher improvements in HRQoL were associated with a higher compliance with the diets (Spearman's rho; -0.183; P = 0.0378) and increased the likelihood of sustained adherence to the LCHF diet.

CONCLUSIONS

HRQoL improved in both dietary intervention groups with no difference between groups. Dietary compliance was associated with improved HRQoL and may play a role in sustained adherence to the LCHF diet. This trial was registered at clinicaltrials.gov as NCT03068078.