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.
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Am J Clin Nutr. 2023 May;117(5):870-882. doi: 10.1016/j.ajcnut.2023.03.018. Epub 2023 Mar 25.
Limited evidence is available on the dose-dependent effects of calorie restriction in patients with type 2 diabetes.
We aimed to gather available evidence on the effect of calorie restriction on the management of type 2 diabetes.
We systematically searched PubMed, Scopus, CENTRAL, Web of Science, and gray literature until November 2022 for randomized trials >12 wk looking at the effect of a prespecified calorie-restricted diet on remission of type 2 diabetes. We performed random-effects meta-analyses to estimate the absolute effect (risk difference) at 6-mo (6 ± 3 mo) and 12-mo (12 ± 3 mo) follow-ups. Then, we performed dose-response meta-analyses to estimate the mean difference (MD) for the effects of calorie restriction on cardiometabolic outcomes. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to judge the certainty of evidence.
Twenty-eight randomized trials with 6281 participants were included. Using a remission definition of an HbA1c level of <6.5% without antidiabetic medication use, calorie-restricted diets increased remission by 38 more per 100 patients (95% CI: 9 more, 67 more; n = 5 trials; GRADE = moderate) at 6 mo and by 13 more per 100 patients (95% CI: 10 more, 18 more; n = 4; GRADE = moderate) at 12 mo in comparison to usual diet or usual care. Using a definition of HbA1c of <6.5% after at least 2-mo cessation of antidiabetic medications, remission increased by 34 more per 100 patients (95% CI: 15 more, 53 more; n = 1; GRADE = very low) at 6 mo and by 16 more per 100 patients (95% CI: 4 more, 49 more; n = 2; GRADE = low) at 12 mo. At 6 mo, each 500-kcal/d decrease in energy intake resulted in clinically meaningful reductions in body weight (MD: -6.33 kg; 95% CI: -7.76, -4.90; n = 22; GRADE = high) and HbA1c (MD: -0.82%; 95% CI: -1.05, -0.59; n = 18; GRADE = high), which attenuated remarkably at 12 mo.
Calorie-restricted diets may be effective intervention for type 2 diabetes remission, especially when coupled with an intensive lifestyle modification program. This systematic review was registered in PROSPERO as CRD42022300875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 300875). Am J Clin Nutr 2023;xxx:xx-xx.
目前有关热量限制对 2 型糖尿病患者的剂量依赖性影响的证据有限。
我们旨在收集有关热量限制对 2 型糖尿病管理影响的现有证据。
我们系统地检索了 PubMed、Scopus、CENTRAL、Web of Science 和灰色文献，以查找超过 12 周的、观察特定热量限制饮食对 2 型糖尿病缓解效果的随机试验。我们进行了随机效应荟萃分析，以估计 6 个月（6±3 个月）和 12 个月（12±3 个月）随访时的绝对效果（风险差）。然后，我们进行了剂量-反应荟萃分析，以估计热量限制对心血管代谢结局的影响的均数差值（MD）。我们使用推荐评估、制定与评价（GRADE）方法来判断证据的确定性。
共纳入了 28 项随机试验，涉及 6281 名参与者。使用糖化血红蛋白（HbA1c）水平<6.5%且不使用抗糖尿病药物的缓解定义，与常规饮食或常规护理相比，热量限制饮食可使每 100 名患者多缓解 38 例（95%CI：9 例，67 例；n=5 项试验；GRADE=中等），在 12 个月时多缓解 13 例（95%CI：10 例，18 例；n=4 项；GRADE=中等）。使用至少停用抗糖尿病药物 2 个月后 HbA1c<6.5%的缓解定义，每 100 名患者的缓解增加 34 例（95%CI：15 例，53 例；n=1 项；GRADE=极低），在 6 个月时增加 16 例（95%CI：4 例，49 例；n=2 项；GRADE=低）。在 6 个月时，能量摄入每减少 500kcal/d，体重（MD：-6.33kg；95%CI：-7.76，-4.90；n=22；GRADE=高）和 HbA1c（MD：-0.82%；95%CI：-1.05，-0.59；n=18；GRADE=高）均有显著降低，而 12 个月时则明显减弱。
热量限制饮食可能是 2 型糖尿病缓解的有效干预措施，尤其是当与强化生活方式改变方案相结合时。本系统评价已在 PROSPERO 中注册为 CRD42022300875（https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=300875）。美国临床营养学杂志 2023 年；xxx：xx-xx。
