Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis

We evaluated the effects of ketogenic diets (KDs) on body mass (BM), fat mass (FM), fat-free mass (FFM), body mass index (BMI), and body fat percentage (BFP) compared to non-KDs in individuals performing resistance training (RT). Online electronic databases including PubMed, the Cochrane Library, Web of Science, Embase, SCOPUS, and Ovid were searched to identify initial studies until February 2021. Data were pooled using both fixed and random-effects methods and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Out of 1372 studies, 13 randomized controlled trials (RCTs) that enrolled 244 volunteers were included. The pooled results demonstrated that KDs significantly decreased BM [(WMD = −3.67 kg; 95% CI: −4.44, −2.90, <i>p</i> &lt; 0.001)], FM [(WMD = −2.21 kg; 95% CI: −3.09, −1.34, <i>p</i> &lt; 0.001)], FFM [(WMD = −1.26 kg; 95% CI: −1.82, −0.70, <i>p</i> &lt; 0.001)], BMI [(WMD = −1.37 kg.m⁻²; 95% CI: −2.14, −0.59, <i>p</i> = 0.022)], and BFP [(WMD = −2.27%; 95% CI: −3.63, −0.90, <i>p</i> = 0.001)] compared to non-KDs. We observed beneficial effects of KDs compared to non-KDs on BM and body fat (both FM and BFP) in individuals performing RT. However, adherence to KDs may have a negative effect on FFM, which is not ameliorated by the addition of RT.