BACKGROUND: The low-carbohydrate-ketogenic diet, an effective strategy to address metabolic syndrome (MetS) and obesity has raised concerns about high-fat consumption on atherogenic lipoproteins. OBJECTIVE: The aim of this study was to compare the Asian ketogenic diet (AKD), which incorporates balanced protein and fat intake from Asian foods, with a balanced low-caloric diet (BLC) in individuals diagnosed with MetS. METHODS: A 52-wk randomized clinical trial included 3 parallel groups: AKD with increased whole egg intake [egg yolk Asian ketogenic diet (Yolk-AKD, n = 28)], yolk-free ketogenic diet with egg white supplementation [egg white Asian ketogenic diet (White-AKD, n = 26)], and BLC (n = 22). Primary outcomes were anthropometric and metabolic changes. RESULTS: The AKD groups achieved significant reductions in weight and waist circumference (P < 0.05). Compared with the BLC group, the AKD groups demonstrated significant improvements in insulin resistance at week 6 and in triglyceride concentrations at weeks 12 (Yolk-AKD) and 35 (White-AKD) (P < 0.05). The AKD groups experienced improvements in hormones associated with insulin sensitivity and appetite, whereas only the Yolk-AKD group had a significant decrease in inflammation-related hormones (P < 0.05). From weeks 35-52, the AKD maintained reductions in anthropometric measurements, blood pressure, improved glucose tolerance, enhanced lipid profiles, and better liver function compared with the BLC. CONCLUSIONS: The AKD proved safe and effective, yielding various metabolic improvements in individuals with MetS compared with the BLC. Emphasizing a low-saturated fat diet while disregarding dietary cholesterol, this approach holds promise for MetS and obesity management. The inclusion of both White-AKD and Yolk-AKD groups allowed for a comprehensive assessment of the AKD's impact, elucidating the differential effects of whole egg consumption on metabolic outcomes. Further studies are warranted. This trial was registered at clinicaltrials.gov as NCT04608136.