素食饮食模式对糖尿病患者心血管代谢风险因素的影响：系统评价和随机对照试验的荟萃分析。

Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials.

机构信息

Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.

出版信息

Clin Nutr. 2019 Jun;38(3):1133-1145. doi: 10.1016/j.clnu.2018.05.032. Epub 2018 Jun 13.

DOI:10.1016/j.clnu.2018.05.032

PMID:29960809

Abstract

BACKGROUND & AIMS: To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of randomized controlled trials to summarize the evidence for the effect of vegetarian dietary patterns on glycemic control and other established cardiometabolic risk factors in individuals with diabetes.

METHODS

We searched MEDLINE, EMBASE, and Cochrane databases through February 26, 2018 for randomized controlled trials ≥3 weeks assessing the effect of vegetarian dietary patterns in individuals with diabetes. The primary outcome was HbA. Secondary outcomes included other markers of glycemic control, blood lipids, body weight/adiposity, and blood pressure. Two independent reviewers extracted data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I statistic). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Nine trials (n = 664 participants) met the eligibility criteria. Vegetarian dietary patterns significantly lowered HbA (MD = -0.29% [95% CI: -0.45, -0.12%]), fasting glucose (MD = -0.56 mmol/L [95% CI: -0.99, -0.13 mmol/L]), LDL-C (MD = -0.12 mmol/L [95% CI: -0.20, -0.04 mmol/L]), non-HDL-C (MD = -0.13 mmol/L [95% CI: -0.26, -0.01 mmol/L]), body weight (MD = -2.15 kg [95% CI: -2.95, -1.34 kg]), BMI (MD = -0.74 kg/m [95% CI: -1.09, -0.39 kg/m]) and waist circumference (MD = -2.86 cm [95% CI: -3.76, -1.96 cm]). There was no significant effect on fasting insulin, HDL-C, triglycerides or blood pressure. The overall certainty of evidence was moderate but was low for fasting insulin, triglycerides and waist circumference.

CONCLUSION

Vegetarian dietary patterns improve glycemic control, LDL-C, non-HDL-C, and body weight/adiposity in individuals with diabetes, supporting their inclusion for diabetes management. More research is needed to improve our confidence in the estimates. CLINICALTRIALS.

GOV IDENTIFIER

NCT02600377.

摘要

背景与目的

为了更新欧洲糖尿病研究协会（EASD）的营养治疗临床实践指南，我们进行了一项系统评价和荟萃分析，以总结素食饮食模式对糖尿病患者血糖控制和其他已确立的心血管代谢风险因素的影响的证据。

方法

我们通过 2018 年 2 月 26 日的 MEDLINE、EMBASE 和 Cochrane 数据库搜索了≥3 周评估糖尿病患者素食饮食模式影响的随机对照试验。主要结局是 HbA。次要结局包括其他血糖控制标志物、血脂、体重/肥胖和血压。两名独立审查员提取数据并评估偏倚风险。数据通过通用逆方差法进行汇总，并以均数差（MD）和 95%置信区间（CI）表示。使用 Cochran Q 统计量评估异质性，并使用 I 统计量进行量化。使用推荐评估、制定与评价（GRADE）方法评估证据的总体确定性。

结果

有 9 项试验（n=664 名参与者）符合入选标准。素食饮食模式显著降低了 HbA（MD=-0.29%[95%CI：-0.45，-0.12%]）、空腹血糖（MD=-0.56mmol/L[95%CI：-0.99，-0.13mmol/L]）、LDL-C（MD=-0.12mmol/L[95%CI：-0.20，-0.04mmol/L]）、非 HDL-C（MD=-0.13mmol/L[95%CI：-0.26，-0.01mmol/L]）、体重（MD=-2.15kg[95%CI：-2.95，-1.34kg]）、BMI（MD=-0.74kg/m[95%CI：-1.09，-0.39kg/m]）和腰围（MD=-2.86cm[95%CI：-3.76，-1.96cm]）。空腹胰岛素、HDL-C、甘油三酯和血压无显著影响。证据的总体确定性为中等，但空腹胰岛素、甘油三酯和腰围的确定性较低。