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Changes in ectopic lipids, insulin sensitivity, and beta cell function after a low-fat vegan diet in adults with type 2 diabetes: a 16-week single-arm clinical trial
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October 2026
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In adults with type 2 diabetes, 16 weeks of an ad libitum low-fat vegan diet, with no prescribed caloric target, was associated with reductions in body weight (6.6%), visceral fat, and hepatocellular lipid content (33%) and with reduced tissue AGE accumulation. Because there was no control group, these changes cannot be attributed specifically to dietary composition independent of the accompanying reduction in energy intake and weight loss.
Abstract
Objective The aim of this study was to explore the effects of a low-fat plant-based diet on hepatocellular and intramyocellular lipids, advanced glycation end products (AGEs), insulin resistance, and beta-cell function in adults with type 2 diabetes.
Research design and methods Participants (n=25) were asked to follow a low-fat vegan diet for 16 weeks. Dual X-ray absorptiometry was used to measure body composition. Hepatocellular and intramyocellular lipids were quantified by 1H magnetic resonance spectroscopy. Tissue accumulation of AGEs was measured using a skin fluorescence technique. Insulin resistance was assessed in a fasting state with the Homeostasis Model Assessment (HOMA-IR) index. Postprandial insulin sensitivity was assessed with the predicted insulin sensitivity index (PREDIM). Beta-cell function was calculated by a mathematical model after a standard meal, using C-peptide deconvolution.
Results Mean body weight decreased by 6.0 kg (95% CI -7.0 to -5.1; p<0.001), a 6.6% (95% CI -7.5 to -5.8) decrease relative to baseline. This was largely due to the reduction in fat mass (-4.2 kg, 95% CI -5.7 to -2.7; p<0.001). Visceral fat volume decreased by 290 cm3 (95% CI -467 to -114; p=0.003). Hepatocellular lipids decreased by 33.0% (95% CI -48.7 to -17.3; p<0.001). The AGE score decreased by 0.4 (95% CI -0.6 to -0.2; p=0.002). The HOMA-IR index, a measure of insulin resistance, fell (-2.5, 95% CI -4.1 to -0.9; p=0.004), whereas PREDIM, a measure of insulin sensitivity, increased on the vegan diet (+1.3 mg/min/kg, 95% CI +0.6 to +2.1; p=0.002). Several markers of beta-cell function improved on the vegan diet. Specifically, insulin secretion at 6 and 7 mmol/L glucose, beta-cell glucose sensitivity, rate sensitivity, and potentiation factor all increased.
Conclusions On an ad libitum low-fat plant-based (vegan) dietary intervention, the participants with type 2 diabetes experienced reductions in ectopic fat, particularly visceral and hepatocellular fat, improvements in insulin sensitivity, reductions in AGEs, and improvements in beta-cell function.
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