富含单不饱和脂肪酸的糖尿病专用配方与糖尿病或高血糖患者的代谢结局：系统评价和荟萃分析。

Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis.

机构信息

Nutrition Department of University Hospital Miguel Servet, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud (IACS), Spain.

Endocrinology and Nutrition Unit, Hospital Clínico San Carlos, Madrid, Spain; Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

出版信息

Clin Nutr. 2020 Nov;39(11):3273-3282. doi: 10.1016/j.clnu.2020.02.036. Epub 2020 Mar 16.

DOI:10.1016/j.clnu.2020.02.036

PMID:32222291

Abstract

OBJECTIVE

The aim of this study was to compare the metabolic benefits of diabetes-specific formulas (DSF) high in monounsaturated fatty acids (MUFA) with standard formulas (STDF) in adult patients with type 1, type 2 diabetes or stress-induced hyperglycaemia.

RESEARCH DESIGN AND METHODS

A systematic review and meta-analysis were conducted through a literature search using different electronic databases from the index date to December 2018. We included randomised controlled trials that assessed the health benefits of high MUFA DSF vs STDF. Included outcomes were glycaemic control, lipid metabolism and tolerance. Effect sizes were calculated as standardised mean differences (SMDs) (<0.4 were considered small, 0.4-0.7 moderate and >0.7 large). This systematic review was registered as CRD42018108931 on Prospero.

RESULTS

Of 385 references reviewed, 18 studies involving 845 adults met our inclusion criteria and contributed to the meta-analysis. Use of a high MUFA DSF compared with a STDF was associated with a statistically significant decrease in peak of postprandial glucose [SMD -1.53, 95% confidence interval (CI) -2.44 to -0.61], incremental glucose response (SMD -1.19, 95% CI -1.71 to -0.68), area under the curve of plasma insulin (SMD -0.65, 95% CI -1.03 to -0.26), mean blood glucose level (SMD -0.41, 95% CI -0.63 to -0.19), glycosylated haemoglobin (HbA1c) change (SMD -0.63, 95% CI -1.21 to -0.05), glucose variability (SMD -0.93, -1.55 to -0.31), mean administered insulin dose (SMD -0.49, 95% CI -0.85 to -0.14), mean blood triglycerides (SMD -0.34, 95% CI -0.65 to -0.03) and increase of mean blood high-density lipoproteins (SMD +0.42, 95% CI 0.08 to 0.76). Non-significant differences were found for tolerance [odds ratio (OR) 0.95, 95% CI 0.87 to 1.05].

CONCLUSIONS

This meta-analysis shows that a DSF (oral supplements and tube feeds) high in MUFAs can improve glucose control and metabolic risk factors among patients with diabetes or stress-induced hyperglycaemia compared with a STDF.

摘要

目的

本研究旨在比较富含单不饱和脂肪酸（MUFA）的糖尿病专用配方（DSF）与标准配方（STDF）在 1 型、2 型糖尿病或应激性高血糖成人患者中的代谢益处。

研究设计和方法

通过对从索引日期到 2018 年 12 月的不同电子数据库进行文献检索，进行了系统评价和荟萃分析。我们纳入了评估高 MUFA DSF 与 STDF 对健康益处的随机对照试验。纳入的结局为血糖控制、脂质代谢和耐受性。效应大小计算为标准化均数差（SMD）（<0.4 为小，0.4-0.7 为中，>0.7 为大）。本系统评价在 Prospero 上注册为 CRD42018108931。

结果

在 385 篇综述中，有 18 项研究涉及 845 名成年人符合纳入标准并纳入荟萃分析。与 STDF 相比，使用高 MUFA DSF 与餐后血糖峰值显著降低相关 [SMD-1.53，95%置信区间（CI）-2.44 至-0.61]、增量葡萄糖反应（SMD-1.19，95%CI-1.71 至-0.68）、血浆胰岛素曲线下面积（SMD-0.65，95%CI-1.03 至-0.26）、平均血糖水平（SMD-0.41，95%CI-0.63 至-0.19）、糖化血红蛋白（HbA1c）变化（SMD-0.63，95%CI-1.21 至-0.05）、血糖变异性（SMD-0.93，-1.55 至-0.31）、平均胰岛素剂量（SMD-0.49，95%CI-0.85 至-0.14）、平均血液三酰甘油（SMD-0.34，95%CI-0.65 至-0.03）和平均血液高密度脂蛋白（SMD+0.42，95%CI 0.08 至 0.76）升高。耐受性方面未发现显著差异[比值比（OR）0.95，95%CI 0.87 至 1.05]。