J Acad Nutr Diet. 2017 Oct;117(10):1578-1611. doi: 10.1016/j.jand.2017.06.361.
Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library's prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong.
Present the basis of systematic reviews for MNT and weight loss recommendations.
Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months.
Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated.
For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure.
Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes.
基于系统评价，为预防 2 型糖尿病的证据分析库项目制定了 11 项建议。其中两项建议——医学营养疗法（MNT）和减肥——被评为强推荐。
介绍 MNT 和减肥推荐的系统评价依据。
使用 Medline 进行文献检索，以确定符合入选标准的研究。MNT 文献检索涵盖了 1995 年至 2012 年的时间段，而减肥文献检索则涵盖了 2008 年至 2012 年，因为纳入了 2008 年发表的一项 Cochrane 综述随机对照试验（RCT）的荟萃分析。纳入文章的标准包括使用更高质量研究设计（即 RCT、病例对照、队列、交叉和非随机试验）的原始研究，研究对象年龄大于 18 岁，符合糖尿病前期或代谢综合征的诊断标准。MNT 定义为个体化的，由注册营养师或国际等效人员提供，减肥干预的持续时间至少为 3 个月。
2 小时餐后血糖水平、糖化血红蛋白水平、白蛋白/肌酐比（仅代谢综合征样本）、空腹血糖水平、高密度脂蛋白胆固醇水平、收缩压和舒张压、甘油三酯水平、尿白蛋白排泄率（仅代谢综合征样本）、腰围（WC）和腰臀比。
对于 MNT，共纳入 11 项研究，均采用 RCT 研究设计，其中 10 项研究纳入糖尿病前期患者。大多数研究报告称血糖相关结局、WC 和血压有显著改善。对于减肥，共确定了 28 项研究，其中 1 项荟萃分析（仅纳入 RCT）和 20 项采用 RCT 研究设计，其中荟萃分析和 10 项 RCT 纳入糖尿病前期患者。大多数研究报告称血糖相关结局、甘油三酯水平、WC 和血压有显著改善。
系统评价提供了有力的证据，表明 MNT 和减肥可以改变临床参数，从而降低患 2 型糖尿病的风险。
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