The efficacy of carbohydrate-restricted diets on reducing visceral and liver fat in individuals with overweight and obesity: a systematic review and pairwise and network meta-analyses

The current systematic review aimed to investigate the efficacy of carbohydrate-restricted diets (CRDs) for improving fat distribution in individuals with overweight or obesity. A comprehensive search was conducted in PubMed, Web of Science, and Scopus from inception to April 2025. Randomized trials investigating the effects of any mode of CRD, including moderate (MCD), low (LCD), or very low (VLCD) carbohydrate diets, as compared with a control group (CON) or other dietary interventions such as caloric restriction (CR), low-fat diets (LFD), or intermittent fasting (IF), were included. Results showed that CRDs significantly reduced visceral and liver fat compared with pre-intervention values. Compared with CON, VLCD, LCD, and MCD led to significantly larger reductions in visceral fat. In addition, IF, LFD, and CR reduced visceral fat. When comparing CRD modes, VLCD were significantly more effective than MCD. According to the P-score rankings, the highest ranking was observed for IF (0.91), followed by VLCD (0.84), LFD (0.62), LCD (0.46), CR (0.42), and MCD (0.25). CRDs, particularly VLCD, can be effective for reducing visceral and liver fat content in individuals with overweight and obesity, and may be considered as an alternative dietary therapy for managing obesity.