Effects of Low-Carbohydrate and Ketogenic Diets on Aerobic Performance in Trained Athletes: A Systematic Review and Meta-Analysis.

Publication Bias and Quality Considerations The minimal evidence of publication bias (Egger’s regression coefficient = 0.54, 95% CI: −0.18 to 1.26, p = 0.128 approaching but not reaching significance; Begg’s rank correlation tau = 0.08, p = 0.052 indicating modest asymmetry; trim-and-fill analysis identifying only two potentially missing studies with minimal effect on conclusions) suggests that findings are not substantially distorted by selective publication of positive results.

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Publication bias assessment revealed minimal evidence of selective reporting bias: Egger’s regression test approached but did not reach significance (coefficient = 0.54, 95% CI: −0.18 to 1.26, p = 0.128), Begg’s test showed modest asymmetry (tau = 0.08, p = 0.052), trim-and-fill analysis identified only 2 potentially missing studies with minimal effect on pooled estimates, and universal concordance of all 30 fat oxidation studies (100% showing increased rates with 18 p < 0.001) demonstrates absence of selective reporting for this outcome.

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Rowlands and Hopkins documented 3–4% faster 100 km time trials with low-carbohydrate diets, though this did not reach statistical significance ( p = 0.16–0.22) [ 28 ].

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For metabolic variables examining fat oxidation across 30 studies, sequential exclusion revealed no influential outliers, with pooled fat oxidation increase remaining highly significant (Cohen’s d = 1.72, 95% CI: 1.42–2.02) after excluding the study with the largest effect (Volek et al., which showed a 2.3-fold increase [ 7 ]), indicating robust findings across independent investigations.

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