Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Am J Clin Nutr. 2022 Jul 6;116(1):40-56. doi: 10.1093/ajcn/nqac066.
Carbohydrate restriction is effective for type 2 diabetes management.
We aimed to evaluate the dose-dependent effect of carbohydrate restriction in patients with type 2 diabetes.
We systematically searched PubMed, Scopus, and Web of Science to May 2021 for randomized controlled trials evaluating the effect of a carbohydrate-restricted diet (≤45% total calories) in patients with type 2 diabetes. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included fasting plasma glucose (FPG); body weight; serum total, LDL, and HDL cholesterol; triglyceride (TG); and systolic blood pressure (SBP). We performed random-effects dose-response meta-analyses to estimate mean differences (MDs) for a 10% decrease in carbohydrate intake.
Fifty trials with 4291 patients were identified. At 6 months, compared with a carbohydrate intake between 55%-65% and through a maximum reduction down to 10%, each 10% reduction in carbohydrate intake reduced HbA1c (MD, -0.20%; 95% CI, -0.27% to -0.13%), FPG (MD, -0.34 mmol/L; 95% CI, -0.56 to -0.12 mmol/L), and body weight (MD, -1.44 kg; 95% CI, -1.82 to -1.06 kg). There were also reductions in total cholesterol, LDL cholesterol, TG, and SBP. Levels of HbA1c, FPG, body weight, TG, and SBP decreased linearly with the decrease in carbohydrate intake from 65% to 10%. A U-shaped effect was seen for total cholesterol and LDL cholesterol, with the greatest reduction at 40%. At 12 months, a linear reduction was seen for HbA1c and TG. A U-shaped effect was seen for body weight, with the greatest reduction at 35%.
Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake. U-shaped effects were seen for total cholesterol and LDL cholesterol at 6 months and for body weight at 12 months.
碳水化合物限制对 2 型糖尿病管理有效。
我们旨在评估碳水化合物限制对 2 型糖尿病患者的剂量依赖性影响。
我们系统地检索了 PubMed、Scopus 和 Web of Science 以获取评估 2 型糖尿病患者低碳水化合物饮食（总热量的≤45%）效果的随机对照试验，截至 2021 年 5 月。主要结局是糖化血红蛋白（HbA1c）。次要结局包括空腹血糖（FPG）；体重；血清总胆固醇、LDL 胆固醇和 HDL 胆固醇；甘油三酯（TG）；和收缩压（SBP）。我们进行了随机效应剂量-反应荟萃分析，以估计碳水化合物摄入量减少 10%的平均差异（MDs）。
确定了 50 项试验，共纳入 4291 名患者。在 6 个月时，与碳水化合物摄入量在 55%-65%之间并最大程度地减少到 10%相比，碳水化合物摄入量每减少 10%，HbA1c（MD，-0.20%；95%CI，-0.27%至-0.13%）、FPG（MD，-0.34mmol/L；95%CI，-0.56 至-0.12 mmol/L）和体重（MD，-1.44kg；95%CI，-1.82 至-1.06 kg）均降低。总胆固醇、LDL 胆固醇、TG 和 SBP 也有所降低。从 65%降至 10%，HbA1c、FPG、体重、TG 和 SBP 呈线性下降。总胆固醇和 LDL 胆固醇呈 U 型效应，降幅最大为 40%。在 12 个月时，HbA1c 和 TG 呈线性降低。体重呈 U 型效应，降幅最大为 35%。
碳水化合物限制可显著降低 2 型糖尿病患者的心血管代谢危险因素水平。大多数心血管代谢结局的水平与碳水化合物摄入量的减少呈线性相关。6 个月时总胆固醇和 LDL 胆固醇呈 U 型效应，12 个月时体重呈 U 型效应。
