Very-Low-Carbohydrate Diet for Prediabetes and Obesity

Obesity and prediabetes frequently coexist and share a common pathophysiological pathway: excess visceral adiposity promotes chronic low-grade inflammation and insulin resistance, accelerating progression from normoglycaemia to prediabetes and ultimately to type 2 diabetes mellitus (T2DM). While carbohydrate-restricted dietary interventions have demonstrated efficacy for weight loss and glycaemic improvement in patients with established T2DM and diabetic kidney disease, their effects have not been well characterised in the earlier, potentially reversible stage of prediabetes, where intervention may carry the greatest preventive value. This single-centre, randomized controlled trial evaluates the effects of a 12-week very-low-carbohydrate diet (VLCBD, less than 50 g carbohydrate/day) compared with standard dietary advice (no specific carbohydrate restriction) in adults with obesity and prediabetes attending a tertiary endocrine outpatient clinic in Malaysia. Both study arms receive individualised caloric intake based on ideal body weight, structured dietary counselling, and food diaries for adherence monitoring. The study compares the two dietary approaches with respect to anthropometric and body composition changes, insulin resistance, and the safety and feasibility of the VLCBD approach over the 12-week intervention period, with assessments at baseline and at Week 12. Findings are intended to inform whether carbohydrate restriction is a feasible, safe, and effective dietary strategy for reducing cardiometabolic risk and preventing progression to type 2 diabetes in adults with prediabetes and obesity - a population not directly addressed by prior low-carbohydrate diet trials, which have been conducted mainly in patients with established diabetes.