The effect of the modified atkins diet on serum adipokine levels in patients with overweight, obesity, and metabolic syndrome: A systematic review and meta-analysis of controlled trials

Background: Overweight, obesity, and metabolic syndrome are associated with adipose tissue dysfunction and altered adipokine secretion. The Modified Atkins Diet (MAD), a less restrictive ketogenic diet, may improve metabolic health and regulate adipokines, but evidence remains inconsistent. This study evaluated the effects of MAD on serum leptin, adiponectin, and ghrelin levels. 
Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020. PubMed, Scopus, and Web of Science were searched in May 2026. Studies were selected using predefined PICO criteria. Risk of bias was assessed using RoB 2 and ROBINS-I. A random-effects model was used, and outcomes were expressed as mean differences (MDs) with 95% confidence intervals (95% CIs). 
Results: Six studies were included. MAD did not significantly affect serum leptin (MD = -2.68; 95% CI = -7.94 to 2.57), adiponectin (MD = -0.34; 95% CI = -0.83 to 0.15), or ghrelin (MD = -57.55; 95% CI = -115.24 to 0.14). Although leptin and ghrelin tended to decrease, adiponectin findings were inconsistent. High heterogeneity was observed across all outcomes. 
Conclusion: Current evidence does not demonstrate a statistically significant effect of MAD on serum leptin, adiponectin, or ghrelin levels in individuals with overweight, obesity, and metabolic syndrome. Larger, well-designed studies with more homogeneous populations, longer intervention durations, and standardized methodologies are needed to clarify these effects.