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Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis
  1. Kurt Sartorius1,2,3,
  2. Benn Sartorius1,2,
  3. Thandinkosi E Madiba2,4,
  4. Cristina Stefan5
  1. 1 Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
  2. 2 University of KwaZulu-Natal Gastrointestinal Cancer Research Centre (GICRC), Durban, South Africa
  3. 3 Faculty of Commerce, University of the Witwatersrand, Johannesburg, South Africa
  4. 4 School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
  5. 5 African Medical Research and Innovation Institute, Cape Town, South Africa
  1. Correspondence to Professor Benn Sartorius; sartorius{at}


Objectives The present study aimed to test the association between high and low carbohydrate diets and obesity, and second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity.

Setting, participants and outcome measures We sought MEDLINE, PubMed and Google Scholar for observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and assessed study quality.

Results The study identified 22 articles that fulfilled the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity. The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity. The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity. Both these pooled strata estimates were, however, not statistically significant.

Conclusions On the basis of the current study, it cannot be concluded that a high-carbohydrate diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity. A central limitation of the study was the non-standard classification of dietary intake across the studies, as well as confounders like total energy intake, activity levels, age and gender. Further studies are needed that specifically classify refined versus unrefined carbohydrate intake, as well as studies that investigate the relationship between high fat, high unrefined carbohydrate–sugar diets.

PROSPERO registration number CRD42015023257.

  • high carbohydrate intake
  • obesity
  • observational

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  • Contributors All authors contributed to the conception and design of the systematic literature review, the collection and screening of publications. KS and BS contributed to the analysis and interpretation of the findings. KS and BS drafted the manuscript. TM and CS reviewed and provided input to revise the manuscript. All authors gave final approval for submission.

  • Funding This study was partly funded through the MRC South Africa (University of KwaZulu-Natal Gastrointestinal Cancer Research Centre (GICRC)).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.