Comparative effect of dietary patterns on selected cardiovascular risk factors: A network study

Cardiovascular disease (CVD) is a major global health concern associated with modifiable risk factors including obesity, hypertension, dyslipidemia, and hyperglycemia. While various dietary patterns have demonstrated cardiovascular benefits, their comparative effectiveness remains unclear. This network meta-analysis (NMA) systematically evaluates the impact of eight dietary patterns on cardiovascular risk markers. We included randomized controlled trials (RCTs) assessing low-fat, Mediterranean, ketogenic, low-carbohydrate, high-protein, vegetarian, intermittent fasting, and DASH diets. A random-effects model analyzed mean differences (MD) in body composition (weight, BMI, waist circumference), lipid profiles (triglycerides, total cholesterol, HDL-C, LDL-C), glycemic markers (glucose), and blood pressure (systolic/diastolic). Dietary efficacy was ranked via Surface Under the Cumulative Ranking Curve (SUCRA) scores. Among 21 RCTs (1,663 participants), ketogenic (MD -10.5 kg, 95% CI -18.0 to -3.05; SUCRA 99) and high-protein diets (MD -4.49 kg, 95% CI -9.55 to 0.35; SUCRA 71) showed superior efficacy for weight reduction. For waist circumference, ketogenic (MD -11.0 cm, 95% CI -17.5 to -4.54; SUCRA 100) and low-carbohydrate diets (MD -5.13 cm, 95% CI -8.83 to -1.44; SUCRA 77) achieved greatest reductions. DASH diet most effectively lowered systolic blood pressure (MD -7.81 mmHg, 95% CI -14.2 to -0.46; SUCRA 89), while intermittent fasting also demonstrated significant blood pressure-lowering effects (MD -5.98 mmHg, 95% CI -10.4 to -0.35; SUCRA 76). Low-carbohydrate (MD 4.26 mg/dL, 95% CI 2.46-6.49; SUCRA 98) and low-fat diets (MD 2.35 mg/dL, 95% CI 0.21-4.40; SUCRA 78) optimally increased HDL-C. Diet-specific cardioprotective effects were observed: ketogenic and high-protein diets excel in weight management, DASH and intermittent fasting in blood pressure control, and carbohydrate-restricted diets in lipid modulation. These findings support personalized dietary strategies for targeted CVD risk factor management.