Møller Grith, Andersen Henning Keinke, Snorgaard Ole
Department of Nutrition, Exercise and Sports, Science, University of Copenhagen, Copenhagen, Denmark.
Cochrane Colorectal Cancer Group, Bispebjerg Hospital, Bispebjerg, Copenhagen, Denmark; and.
Am J Clin Nutr. 2017 Dec;106(6):1394-1400. doi: 10.3945/ajcn.116.139626. Epub 2017 Nov 1.
Despite recommendations, many patients with type 2 diabetes receive dietary advice from nurses or doctors instead of individualized nutrition therapy (INT) that is provided by a dietitian. We performed a meta-analysis to compare the effect of INT that is provided by a registered dietitian with the effect of dietary advice that is provided by other healthcare professionals. A systematic review was conducted of Cochrane library databases, EMBASE, CINAHL, and MEDLINE in the period 2004-2017 for guidelines, reviews, and randomized controlled trials (RCTs) that assessed the outcomes glycated hemoglobin (HbA1c), weight, body mass index (BMI; in kg/m), and LDL cholesterol. Risk of bias and the quality of evidence were assessed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. We identified 5 RCTs comprising 912 participants in total. In the first year of intervention (at 6 or 12 mo), nutrition therapy compared with dietary advice was followed by a 0.45% (95% CI: 0.36%, 0.53%) lower mean difference in HbA1c, a 0.55 (95% CI: 0.02, 1.1) lower BMI, a 2.1-kg (95% CI: 1.2-, 2.9-kg) lower weight, and a 0.17-mmol/L (95% CI: 0.11-, 0.23-mmol/L) lower LDL cholesterol. No longer-term data were available. Some of the included studies had a potential bias, and therefore, the quality of the evidence was low or moderate. In addition, it was necessary to pool primary and secondary outcomes. INT that is provided by a dietitian compared with dietary advice that is provided by other health professionals leads to a greater effect on HbA1c, weight, and LDL cholesterol. Because of the potential bias, we recommend considering nutrition therapy that is provided by a dietitian as part of lifestyle intervention in type 2 diabetes, but further randomized studies are warranted.
尽管有相关建议，但许多2型糖尿病患者从护士或医生那里获得饮食建议，而非由营养师提供的个体化营养治疗（INT）。我们进行了一项荟萃分析，以比较注册营养师提供的INT与其他医疗保健专业人员提供的饮食建议的效果。对2004年至2017年期间的Cochrane图书馆数据库、EMBASE、CINAHL和MEDLINE进行了系统评价，以查找评估糖化血红蛋白（HbA1c）、体重、体重指数（BMI；单位为kg/m）和低密度脂蛋白胆固醇等结局指标的指南、综述和随机对照试验（RCT）。根据推荐分级评估、制定和评价指南评估偏倚风险和证据质量。我们共纳入了5项RCT，总计912名参与者。在干预的第一年（6或12个月时），与饮食建议相比，营养治疗后HbA1c的平均差异降低了0.45%（95%CI：0.36%，0.53%），BMI降低了0.55（95%CI：0.02，1.1），体重降低了2.1kg（95%CI：1.2-，2.9-kg），低密度脂蛋白胆固醇降低了0.17mmol/L（95%CI：0.11-，0.23-mmol/L）。没有长期数据可用。部分纳入研究存在潜在偏倚，因此证据质量为低或中等。此外，有必要汇总主要和次要结局指标。与其他卫生专业人员提供的饮食建议相比，营养师提供的INT对HbA1c、体重和低密度脂蛋白胆固醇有更大影响。由于存在潜在偏倚，我们建议将营养师提供的营养治疗作为2型糖尿病生活方式干预的一部分，但有必要进行进一步的随机研究。
