The Effect of High-Fat Diet on Intramyocellular Lipid Content in Healthy Adults: A Systematic Review, Meta-Analysis and Meta-Regression.

Fatty acids are stored within muscle as intramyocellular lipids (IMCL). Some, but not all, studies indicate that following a high fat diet (HFD), IMCL may accumulate and affect insulin sensitivity. This systematic review and meta-analysis aimed to quantify the effects of a HFD on IMCL. It also explored the potential modifying effects of HFD fat content and duration, IMCL measurement technique, physical activity status, and the associations of IMCL with insulin sensitivity. Five databases were systematically searched for studies that examined the effect of ≥3 days of HFD (>35% daily energy intake from fat) on IMCL content in healthy individuals. Meta-regressions were used to investigate associations of the HFD total fat content, duration, physical activity status, IMCL measurement technique, and insulin sensitivity with IMCL responses. Changes in IMCL content and insulin sensitivity (assessed by hyperinsulinemic-euglycemic clamp) are presented as standardised mean difference (SMD) using a random-effects model with 95% confidence intervals (95% CI). Nineteen studies were included in the systematic review, and 16 in the meta-analysis. IMCL content increased following HFD (SMD=0.63, 95% CI 0.31 to 0.94, p=0.001). IMCL accumulation was not influenced by total fat content (p=0.832) or duration (p=0.844) of HFD, physical activity status (p=0.192) or by the IMCL measurement technique (p>0.05). Insulin sensitivity decreased following HFD (SMD=-0.34, 95% CI -0.52 to -0.16; p=0.003), but this was not related to the increase in IMCL content following HFD (p=0.233). Consumption of a HFD (>35% daily energy intake from fat) for ≥3 days significantly increases IMCL content in healthy individuals regardless of HFD total fat content and duration, or physical activity status. All IMCL measurement techniques detected the increased IMCL content following HFD. The dissociation between changes in IMCL and insulin sensitivity suggests that other factors may drive HFD-induced impairments in insulin sensitivity in healthy individuals. This study was registered with PROSPERO (ref: CRD42021257984).