Aguiar Elroy J, Morgan Philip J, Collins Clare E, Plotnikoff Ronald C, Callister Robin
Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, University Dr, Callaghan, NSW 2308, Australia.
Int J Behav Nutr Phys Act. 2014 Jan 15;11:2. doi: 10.1186/1479-5868-11-2.
Current recommendations for the prevention of type 2 diabetes advise modification of diet and exercise behaviors including both aerobic and resistance training. However, the efficacy of multi-component interventions involving a combination of these three components has not been established. The aims of this review were to systematically review and meta-analyze the evidence on multi-component (diet + aerobic exercise + resistance training) lifestyle interventions for type 2 diabetes prevention. Eight electronic databases (Medline, Embase, SportDiscus, Web of Science, CINAHL, Informit health collection, Cochrane library and Scopus) were searched up to June 2013. Eligible studies 1) recruited prediabetic adults or individuals at risk of type 2 diabetes; 2) conducted diet and exercise [including both physical activity/aerobic and resistance training] programs; and 3) reported weight and plasma glucose outcomes. In total, 23 articles from eight studies were eligible including five randomized controlled trials, one quasi-experimental, one two-group comparison and one single-group pre-post study. Four studies had a low risk of bias (score ≥ 6/10). Median intervention length was 12 months (range 4-48 months) with a follow-up of 18 months (range 6.5-48 months). The diet and exercise interventions varied slightly in terms of their specific prescriptions. Meta-analysis favored interventions over controls for weight loss (-3.79 kg [-6.13, -1.46; 95% CI], Z = 3.19, P = 0.001) and fasting plasma glucose (-0.13 mmol.L⁻¹ [-0.24, -0.02; 95% CI], Z = 2.42, P = 0.02). Diabetes incidence was only reported in two studies, with reductions of 58% and 56% versus control groups. In summary, multi-component lifestyle type 2 diabetes prevention interventions that include diet and both aerobic and resistance exercise training are modestly effective in inducing weight loss and improving impaired fasting glucose, glucose tolerance, dietary and exercise outcomes in at risk and prediabetic adult populations. These results support the current exercise guidelines for the inclusion of resistance training in type 2 diabetes prevention, however there remains a need for more rigorous studies, with long-term follow-up evaluating program efficacy, muscular fitness outcomes, diabetes incidence and risk reduction.
目前预防2型糖尿病的建议是调整饮食和运动行为，包括有氧运动和抗阻训练。然而，包含这三个要素的多组分干预措施的效果尚未得到证实。本综述的目的是系统评价和荟萃分析关于多组分（饮食+有氧运动+抗阻训练）生活方式干预预防2型糖尿病的证据。检索了截至2013年6月的八个电子数据库（Medline、Embase、SportDiscus、Web of Science、CINAHL、Informit health collection、Cochrane图书馆和Scopus）。符合条件的研究：1）招募糖尿病前期成年人或有2型糖尿病风险的个体；2）开展饮食和运动[包括体力活动/有氧运动和抗阻训练]项目；3）报告体重和血浆葡萄糖结果。总共纳入了八项研究中的23篇文章，包括五项随机对照试验、一项半实验性研究、一项两组比较研究和一项单组前后对照研究。四项研究的偏倚风险较低（得分≥6/10）。干预的中位时长为12个月（范围4-48个月），随访时间为18个月（范围6.5-48个月）。饮食和运动干预在具体处方方面略有不同。荟萃分析表明，干预组在体重减轻方面优于对照组（-3.79 kg [-6.13, -1.46；95% CI]，Z = 3.19，P = 0.001），空腹血糖也更低（-0.13 mmol.L⁻¹ [-0.24, -0.02；95% CI]，Z = 2.42，P = 0.02）。仅两项研究报告了糖尿病发病率，与对照组相比分别降低了58%和56%。总之，包含饮食、有氧运动和抗阻训练的多组分生活方式2型糖尿病预防干预措施在诱导体重减轻以及改善糖尿病风险人群和糖尿病前期成年人群的空腹血糖受损、糖耐量、饮食和运动结果方面有一定效果。这些结果支持当前运动指南中关于在2型糖尿病预防中纳入抗阻训练的建议，然而仍需要更严格的研究，进行长期随访以评估项目效果、肌肉适能结果、糖尿病发病率和风险降低情况。
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