Qian Frank, Liu Gang, Hu Frank B, Bhupathiraju Shilpa N, Sun Qi
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA Intern Med. 2019 Oct 1;179(10):1335-1344. doi: 10.1001/jamainternmed.2019.2195.
Accumulating epidemiologic evidence has suggested favorable associations between plant-based dietary patterns and risk of type 2 diabetes, although there is a lack of a quantitative summary of evidence substantiating this important association.
To quantitatively synthesize available prospective observational evidence on the association between plant-based dietary patterns and risk of type 2 diabetes.
A systematic search of PubMed and MEDLINE, Embase, Web of Science, and reference lists through February 15, 2019, was conducted. Data analysis was conducted between December 2018 and February 2019.
All prospective observational studies that examined the association between adherence to plant-based dietary patterns and incidence of type 2 diabetes among adults 18 years or older were identified.
Meta-analysis of Observational Studies in Epidemiology guidelines for data abstraction and reporting were followed, and a National Heart, Lung, and Blood Institute assessment tool was used to evaluate study quality. Two authors independently conducted full-text assessments and data abstraction. Meta-analysis was conducted using the random-effects method to calculate the overall relative risk (RR) and 95% CI.
Level of adherence to a plant-based diet and incidence of type 2 diabetes.
A total of 9 studies were identified, totaling 307 099 participants with 23 544 cases of incident type 2 diabetes. A significant inverse association was observed between higher adherence to a plant-based dietary pattern and risk of type 2 diabetes (RR, 0.77; 95% CI, 0.71-0.84) in comparison with poorer adherence, with modest heterogeneity across studies (I2 = 44.5%; P = .07 for heterogeneity). Similar findings were obtained when using the fixed-effects model (RR, 0.80; 95% CI, 0.75-0.84). Consistent associations were observed across predefined subgroups. This association was strengthened when healthy plant-based foods, such as fruits, vegetables, whole grains, legumes, and nuts, were included in the definition of plant-based patterns (RR, 0.70; 95% CI, 0.62-0.79). Most studies were deemed to have good quality in terms of dietary assessment, disease outcomes, and statistical adjustment for confounding factors. Using restricted cubic splines, a significant inverse linear dose-response association was identified between plant-based dietary indices and risk of type 2 diabetes.
Plant-based dietary patterns, especially when they are enriched with healthful plant-based foods, may be beneficial for the primary prevention of type 2 diabetes.
越来越多的流行病学证据表明，以植物为基础的饮食模式与2型糖尿病风险之间存在有益关联，尽管缺乏对这一重要关联的确凿证据的定量总结。
定量综合关于以植物为基础的饮食模式与2型糖尿病风险之间关联的现有前瞻性观察证据。
对PubMed、MEDLINE、Embase、Web of Science进行了系统检索，并检索了截至2019年2月15日的参考文献列表。数据分析于2018年12月至2019年2月进行。
确定了所有研究18岁及以上成年人中坚持以植物为基础的饮食模式与2型糖尿病发病率之间关联的前瞻性观察研究。
遵循流行病学观察性研究的Meta分析指南进行数据提取和报告，并使用美国国立心肺血液研究所的评估工具来评估研究质量。两位作者独立进行全文评估和数据提取。采用随机效应模型进行Meta分析，以计算总体相对风险（RR）和95%置信区间（CI）。
坚持以植物为基础饮食的程度和2型糖尿病的发病率。
共确定了9项研究，总计307099名参与者，其中23544例为2型糖尿病新发病例。与较低的坚持程度相比，较高的坚持以植物为基础的饮食模式与2型糖尿病风险之间存在显著的负相关（RR=0.77；95%CI：0.71-0.84），各研究之间存在适度异质性（I2=44.5%；异质性P=0.07）。使用固定效应模型时也获得了类似的结果（RR=0.80；95%CI：0.75-0.84）。在预先定义的亚组中观察到一致的关联。当在以植物为基础的模式定义中纳入水果、蔬菜、全谷物、豆类和坚果等健康的植物性食物时，这种关联得到加强（RR=0.70；95%CI：0.62-0.79）。就饮食评估、疾病结局和混杂因素的统计调整而言，大多数研究被认为质量良好。使用受限立方样条，确定了以植物为基础的饮食指数与2型糖尿病风险之间存在显著的负向线性剂量反应关联。
以植物为基础的饮食模式，尤其是富含健康植物性食物的模式，可能对2型糖尿病的一级预防有益。
