Diet Quality Shapes Metabolic Gains Beyond Weight Loss
In a randomized trial, 55 adults with obesity, prediabetes, and excess liver fat followed one of three diets for about five months and lost roughly 10% of their body weight. Although all groups improved metabolically, the ketogenic diet yielded greater reductions in liver fat and better liver insulin sensitivity and blood sugar control. Muscle insulin sensitivity rose by about 50% across all diets.
In a randomized trial, 55 adults with obesity, prediabetes, and extra liver fat ate either a ketogenic low-carb/high-fat plan, a Mediterranean plan, or a high-carb/low-fat plant-forward plan for roughly five months. All received food and weekly dietitian support, and each group lost about 10% of body weight.
Muscle insulin sensitivity rose about 50% regardless of diet, suggesting weight loss drove that change. Liver outcomes differed: ketogenic eating cut liver fat by 67%, versus 45% for the other diets, and improved liver insulin responsiveness two to three times more. Fatty liver disease affects about 75% of adults with obesity worldwide.
This may matter for adults with obesity, prediabetes, and fatty liver, who may face higher risks of diabetes and liver disease. Clinicians could use the findings to discuss diet composition alongside weight loss, though the trial's small size and five-month duration mean longer-term effects remain uncertain. Food access, cost, and adherence may shape whether such diets are practical. It may also encourage more personalized nutrition advice.