Department of Epidemiology, Harvard T.H Chan School of Public Health.
Division of Cardiology, University of Washington.
J Occup Health. 2018 Jan 25;60(1):31-45. doi: 10.1539/joh.17-0121-RA. Epub 2017 Nov 29.
The translation of lifestyle intervention to improve glucose tolerance into the workplace has been rare. The objective of this meta-analysis is to summarize the evidence for the effectiveness of dietary interventions in worksite settings on lowering blood sugar levels.
We searched for studies in PubMed, Embase, Econlit, Ovid, Cochrane, Web of Science, and Cumulative Index to Nursing and Allied Health Literature. Search terms were as follows: (1) Exposure-based: nutrition/diet/dietary intervention/health promotion/primary prevention/health behavior/health education/food /program evaluation; (2) Outcome-based: diabetes/hyperglycemia/glucose/HbA1c/glycated hemoglobin; and (3) Setting-based: workplace/worksite/occupational/industry/job/employee. We manually searched review articles and reference lists of articles identified from 1969 to December 2016. We tested for between-studies heterogeneity and calculated the pooled effect sizes for changes in HbA1c (%) and fasting glucose (mg/dl) using random effect models for meta-analysis in 2016.
A total of 17 articles out of 1663 initially selected articles were included in the meta-analysis. With a random-effects model, worksite dietary interventions led to a pooled -0.18% (95% CI, -0.29 to -0.06; P<0.001) difference in HbA1c. With the random-effects model, the interventions resulted in 2.60 mg/dl lower fasting glucose with borderline significance (95% CI: -5.27 to 0.08, P=0.06). In the multivariate meta-regression model, the interventions with high percent of female participants and that used the intervention directly delivered to individuals, rather the environment changes, were associated with more effective interventions.
Workplace dietary interventions can improve HbA1c. The effects were larger for the interventions with greater number of female participants and with individual-level interventions.
将改善葡萄糖耐量的生活方式干预措施转化为工作场所的措施非常少见。本荟萃分析的目的是总结工作场所饮食干预措施降低血糖水平的有效性证据。
我们在 PubMed、Embase、Econlit、Ovid、Cochrane、Web of Science 和 Cumulative Index to Nursing and Allied Health Literature 中检索了研究。检索词如下：（1）基于暴露的：营养/饮食/饮食干预/健康促进/初级预防/健康行为/健康教育/食物/方案评估；（2）基于结果的：糖尿病/高血糖/葡萄糖/HbA1c/糖化血红蛋白；（3）基于环境的：工作场所/工作地点/职业/工业/工作/雇员。我们手动检索了从 1969 年到 2016 年 12 月期间确定的综述文章和文章参考文献列表。我们检测了研究间的异质性，并使用随机效应模型计算了 HbA1c（%）和空腹血糖（mg/dl）变化的汇总效应大小，以便在 2016 年进行荟萃分析。
在最初选择的 1663 篇文章中，共有 17 篇文章被纳入荟萃分析。使用随机效应模型，工作场所饮食干预措施导致 HbA1c 平均降低 -0.18%（95%CI：-0.29 至-0.06；P<0.001）。使用随机效应模型，干预措施使空腹血糖降低 2.60mg/dl，但具有边缘显著性（95%CI：-5.27 至 0.08，P=0.06）。在多元荟萃回归模型中，干预措施中女性参与者比例较高，以及直接针对个体而不是环境变化进行的干预措施与更有效的干预措施相关。
工作场所饮食干预措施可以改善 HbA1c。对于女性参与者比例较高的干预措施以及针对个体的干预措施，效果更大。
