Evidence map›Paper›PMID 33292205›Full record

ArticleCardiovascular diabetology2020

Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes.

Shaminie J Athinarayanan, Sarah J Hallberg, Amy L McKenzie, Katharina Lechner, Sarah King, James P McCarter, Jeff S Volek, Stephen D Phinney, Ronald M Krauss

Erratum issuedOpen access · goldAbstract readControlled Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Article in Cardiovascular diabetology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 36 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 3 pooled it
4.9field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 3 syntheses or guidelines pooled it, 62 citations in OpenAlex.

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  9. Dietary Management of Atherogenic Dyslipidemia.Current atherosclerosis reports · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 2 countries.

Shaminie J Athinarayanan *Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.ORCID http://orcid.org/0000-0001-5427-6748
Sarah J Hallberg *Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.
Amy L McKenzieVirta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.
Katharina LechnerDepartment of Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany.
Sarah KingSchool of Medicine, University of California, San Francisco, CA, 94143, USA.
James P McCarterAbbott Diabetes Care, Alameda, CA, 94502, USA.
Jeff S VolekVirta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.
Stephen D PhinneyVirta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.
Ronald M KraussSchool of Medicine, University of California, San Francisco, CA, 94143, USA. Ronald.Krauss@ucsf.edu.
University of California, San Francisco · USGerman Centre for Cardiovascular Research · DEIndiana University Health · USThe Ohio State University · USWashington University in St. Louis · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT).

methodsAnalyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles.

resultsAt 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group.

conclusionConsumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.

Indexed as

Diet, Carbohydrate-RestrictedKetosisNutritional StatusBiomarkersCarotid Artery DiseasesCarotid Intima-Media ThicknessDiabetes Mellitus, Type 2DyslipidemiasHeart Disease Risk FactorsHumansLipoproteins, LDLNutritive ValueRisk AssessmentTime FactorsTreatment OutcomeBiomarkersLipoproteins, LDLAtherogenic lipoprotein phenotypeCardiovascular riskLipoprotein sub-fractionationNutritional ketosisType 2 diabetes

Identifiers

PMID33292205
PMCPMC7724865
OpenAlexW3112529462

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.