--- title: "Optimised carbohydrate diet with increased resistant starch to improve metabolic health in adults" id: "bmj-open-14-optimised-carbohydrate-dietary-intervention-for-improving-metabolic-health-in" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-14-optimised-carbohydrate-dietary-intervention-for-improving-metabolic-health-in" content_type: "clinical_feed_article" specialty: "Endocrinology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/9/e123231?rss=1" published_at: "2026-09-08T10:34:54.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Optimised carbohydrate diet with increased resistant starch to improve metabolic health in adults ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-14-optimised-carbohydrate-dietary-intervention-for-improving-metabolic-health-in - **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/9/e123231?rss=1) - **Published At:** 2026-09-08T10:34:54.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - Dietary modification is a key strategy to prevent type 2 diabetes; fibre intake, particularly fermentable fibre, supports metabolic health. - **Resistant starch (RS)** is a fermentable dietary fibre linked in prior research to weight loss, improved insulin sensitivity and better glucose metabolism. - The trial shifts focus from single nutrients to a whole dietary pattern that increases RS and reduces rapidly digestible carbohydrate and free sugars. - This multicentre, randomised, parallel-controlled trial will enrol 250 adults with **pre-diabetes** and randomise them to either a guideline-based conventional diet or an **optimised carbohydrate diet (OCD)**. - In the OCD arm, daily **RS** will be increased to ~40 g and total fibre to 20–40 g per 1000 kcal while reducing rapidly digestible starch and free sugars. - The intervention period is 6 months with a subsequent 3-month post-intervention follow-up. - The primary endpoint is change in **postprandial glycaemic response**, measured as incremental area under the curve (**iAUC**) for plasma glucose during the **OGTT**. - Secondary endpoints include rates of remission to normoglycaemia or progression to type 2 diabetes, changes in other glucose- and lipid-related metabolic measures, and lifestyle/behavioural factors. - Exploratory analyses will assess appetite-related hormones, circulating cytokines, immune function and multi-omics profiles. - Ethics approvals were obtained from Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Approval No. 2025-122; Protocol V.1.0, 20250811) and Shenzhen Center for Chronic Disease Control (Approval No. SZCCC-2024-011-01-PJ). The trial is registered (ChiCTR2500113583). - Results will be submitted for peer-reviewed publication. ## Clinical Analysis & Structured Key Points Introduction Dietary modification is an important strategy for the prevention of type 2 diabetes, with fibre intake recognised as a key factor in promoting metabolic health. Resistant starch (RS), a type of fermentable dietary fibre, has emerged as a promising therapeutic approach due to its association with weight loss, enhanced insulin sensitivity and improved glucose metabolism. As nutritional research progresses, the focus has shifted from individual nutrients to overall dietary patterns. Based on this concept, this study aims to investigate the metabolic effects of a dietary pattern that optimises carbohydrate structure by increasing RS intake and reducing rapidly digestible carbohydrate in adults with pre-diabetes. Methods and analysis This is a multicentre, randomised, parallel-controlled clinical trial, which will enrol 250 adults diagnosed with pre-diabetes. Eligible participants will undergo randomisation to receive either a guideline-based conventional diet or an optimised carbohydrate diet (OCD). In the OCD intervention, daily RS intake will be increased to approximately 40 g, with fibre intake rising to 20 - 40 g per 1000 kcal. At the same time, the intake of rapidly digestible starch and free sugars will be reduced. The intervention will last for 6 months, followed by a 3-month post-intervention follow-up period. The primary outcome is the change in postprandial glycaemic response, assessed using the incremental area under the curve (iAUC) for plasma glucose during the oral glucose tolerance test (OGTT). Secondary outcomes include the proportion of participants achieving remission to normoglycaemia or progressing to type 2 diabetes, changes in other glucose- and lipid-related metabolic parameters and changes in lifestyle-related behavioural factors. Exploratory outcomes will include changes in appetite-related hormones, circulating cytokines, immune function and multi-omics profiles. Ethics and dissemination This study was approved by the Ethics Committee of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Approval No. 2025-122; Protocol V.1.0, 20250811) and the Ethics Committee of Shenzhen Center for Chronic Disease Control (Approval No. SZCCC-2024-011-01-PJ) and registered in the Chinese Clinical Trial Registry. Findings from this study will be disseminated in peer-reviewed journal publications. 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