Background  
Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. It is a condition of impaired blood glucose regulation, significantly increases the risk of developing type-2 diabetes.(1) Low diabetic thresholds is a high risk state with an annualized conversion rate of 5%–10%. The prevalence of pre-diabetes is increasing worldwide, &gt;470 million people will have pre-diabetes in 2030.(2)

Low Carbohydrate High Fat (LCHF) Diet has been popularized by Swedish General practitioner Dr. Annika Dahlqvist. This diet, because of its low requirement for insulin, has been recognised by the Swedish government as being suitable for people with type2 diabetes and helpful to individuals looking to lose weight or maintain a healthy weight.(3)

LCHF diet is a way of eating that restricts the amount of carbohydrates and increases the amount of healthy fats. Consuming fats have very little direct effect on blood glucose levels, and as a result it does not lead to an increase in insulin levels. The principle of LCHF diet is to replace carbohydrate intake with fat, thus reducing insulin levels and increase the body’s ability to utilize its own fat stores for energy.   
Atkins R. proposed the use of LCHF diet for the control of insulin resistance and metabolic syndrome in the decade of seventies.

Aim  
To assess the use of Low Carbohydrate High Fat (LCHF) diet in the treatment of Prediabetes.

Method  
This is a prospective single intervention study. The intervention consisted of carbohydrate intake restriction. Participants are given a diet plan with reduced carbohydrate intake and increase in healthy fats (Like Carbohydrates &lt;26% of total calories, Fats 55-60% &amp; Protein – 20%) by counselling. All the participants were asked to report at end of the third month for consultation.

Results  
A total of 20 subjects were included in the study. The mean age was 36 (range 25-40yrs). 14 were male participants and 6 female participants. At the end of third month, by following the LCHF diet all the participants showed changes in their weight, glycemic profile and lipid profile. There is an average weight loss of 4-6.5 kg; decrease of HbA1c is around 0.3-0.8%. Lipid profile also showed changes like average reduction of 0.04mg/L in TG, average rise of 1.3 to 1.6mmol/dL in HDL and average decrease of 50-120mg/dL in LDL levels.

Discussion  
The main observation of this study was that a LCHF diet was effective in reducing and controlling the risk factors of Prediabetes like weight, glycemic profile and lipid profile but there are several limitations. Most of the participants in this study group were overweight and obese. Some of the studies done on LCHF diet in diabetes, shows some improvements in glycemic control and medication reduction.(3, 4, 5.)

So LCHF diet plan is feasible, acceptable and even effective for the individuals with Prediabetes to lose weight and reduce risk. Based on this pilot study, we can start a fully planned trial on prediabetes with diet plan and medication.

(This work is done as a part of my PhD, Trail Registration number: CTRI/2020/11/029352).

References
1.   
2. Adam G. Tabak, MD, PhD, Christian Herder, PhD et. al., “Prediabetes: A high-risk state for developing diabetes” Lancet . 2012 June 16; 379(9833): 2279–2290.  
3. Parijat De and Sagnik Mukhopadhyay “Low-Carbohydrate High-Fat (LCHF) Diet: Evidence of Its Benefits” July 2017 Chapter 5;70-90.  
4. Christian Lausaavedra “Low- Carbohydrate, High-Fat diet for the management of diabetes mellitus in adults: A Pilot Study, Research Gate Dec 2017.54.   
5. Laura R. Saslow*, Sarah Kim “A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes” PLoS ONE, April 2014 Vol:9(4); e91027.



**Background:**
Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. It is a condition of impaired blood glucose regulation, significantly increases the risk of developing type-2 diabetes.(1) Low diabetic thresholds is a high risk state with an annualized conversion rate of 5%–10%. The prevalence of pre-diabetes is increasing worldwide, >470 million people will have pre-diabetes in 2030.(2)
Low Carbohydrate High Fat (LCHF) Diet has been popularized by Swedish General practitioner Dr. Annika Dahlqvist. This diet, because of its low requirement for insulin, has been recognised by the Swedish government as being suitable for people with type2 diabetes and helpful to individuals looking to lose weight or maintain a healthy weight.(3)
LCHF diet is a way of eating that restricts the amount of carbohydrates and increases the amount of healthy fats. Consuming fats have very little direct effect on blood glucose levels, and as a result it does not lead to an increase in insulin levels. The principle of LCHF diet is to replace carbohydrate intake with fat, thus reducing insulin levels and increase the body’s ability to utilize its own fat stores for energy.
Atkins R. proposed the use of LCHF diet for the control of insulin resistance and metabolic syndrome in the decade of seventies.

**Aim:**
To assess the use of Low Carbohydrate High Fat (LCHF) diet in the treatment of Prediabetes.

**Method:**
This is a prospective single intervention study. The intervention consisted of carbohydrate intake restriction. Participants are given a diet plan with reduced carbohydrate intake and increase in healthy fats (Like Carbohydrates <26% of total calories, Fats 55-60% & Protein – 20%) by counselling. All the participants were asked to follw the given diet and report after three months for consultation.

**Results:**
A total of 20 subjects were included in the study. The mean age was 36 (range 25-40yrs). 14 were male participants and 6 female participants. At the end of third month, by following the LCHF diet all the participants showed changes in their weight, glycemic profile and lipid profile. There is an average weight loss of 4-6.5 kg; decrease of HbA1c is around 0.3-0.8%. Lipid profile also showed changes like average reduction of 0.04mg/L in TG, average rise of 1.3 to 1.6mmol/dL in HDL and average decrease of 50-120mg/dL in LDL levels.

**Discussion:**
The main observation of this study was that a LCHF diet was effective in reducing and controlling the risk factors of Prediabetes like weight, glycemic profile and lipid profile but there are several limitations. Most of the participants in this study group were overweight and obese. Some of the studies done on LCHF diet in diabetes, shows some improvements in glycemic control and medication reduction.(3, 4, 5.)
So LCHF diet plan is feasible, acceptable and even effective for the individuals with Prediabetes to lose weight and reduce risk. But ideally, a diet plan should be developed in collaboration with the person with prediabetes when the diagnosis is made. Diet & Nutrition therapy recommendations need to be adjusted regularly based on changes in an individual’s life circumstances, preferences, and disease course. Regular follow-ups is also very important to adjust other aspects of the treatment plans.
Based on this pilot study, we can start a fully planned trial on prediabetes with diet plan and medication.
(This work is done as a part of my PhD, Trial Registration number: CTRI/2020/11/029352).

**References:**
1. James W. Keck, MD, MPH, “Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice” Journal American Board Family Medicine 2019, 32: 4, 505-512.
2. Adam G. Tabak, MD, PhD, Christian Herder, PhD et. al., “Prediabetes: A high-risk state for developing diabetes” Lancet . 2012 June 16; 379(9833): 2279–2290.
3. Parijat De and Sagnik Mukhopadhyay “Low-Carbohydrate High-Fat (LCHF) Diet: Evidence of Its Benefits” July 2017 Chapter 5;70-90.
4. Christian Lausaavedra “Low- Carbohydrate, High-Fat diet for the management of diabetes mellitus in adults: A Pilot Study, Research Gate Dec 2017.54.
5. Laura R. Saslow*, Sarah Kim “A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes” PLoS ONE, April 2014 Vol:9(4); e91027.

Effects of Low Carbohydrate High Fat (LCHF) Diet in Prediabetic patients – A Pilot Study.