Ten RCTs (n=236 )were included, of which 5 were crossover studies (n=100).
Seven RCTs (n=177) were double-blinded . The Jadad scores ranged from 2 to 4.
There were 8 studies of ST versus LCT. Compared with the LCT group, the ST group had a significantly higher levels of REE (WMD 1.54, 95% CI: 1.26, 1.82, p<0.00001; 4 RCTs) and significantly lower levels of plasma glycerol (WMD 0.14, 95% CI: 0.06, 0.22, p=0.0007; 5 RCTs), free fatty acids (WMD 0.24, 95% CI: 0.10, 0.37, p=0.0006; 8 RCTs) and β-hydroxybutyric acid (WMD 0.14, 95% CI: 0.06, 0.22, p=0.0007; 7 RCTs). There was no statistically significant difference between the groups for nitrogen balance (5 RCTs), respiratory quotient (4 RCTs) and plasma triglycerides (7 RCTs). Random-effects models were used for all outcomes except REE.
There were 2 studies of ST versus MCT/LCT. The studies were clinically heterogeneous and inconclusive, and data were not reported in the review.
All studies gave details of clinical and laboratory safety assessments. No clinical adverse effects were considered likely to be treatment related.