Department of Endocrinology, Pinghu First People's Hospital, Pinghu, 314200, Zhejiang, Republic of China.
Endocrine. 2024 Oct;86(1):85-100. doi: 10.1007/s12020-024-03882-5. Epub 2024 May 30.
Despite several epidemiological studies reporting a significant association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of diabetes mellitus, the results remain controversial. In this systematic review and meta-analysis, we aimed to summarize the existing evidence from published observational studies and evaluate the dose-response relationship between adherence to the DASH diet and diabetes mellitus risk.
We performed a systematic search for relevant articles published up to September 2023 using electronic databases of PubMed, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). A random-effects model was applied to calculate the combined relative risks (RR) with 95% confidence intervals (CIs) for the highest compared to the lowest categories of DASH score in relation to diabetes mellitus risk. Heterogeneity among the included studies was assessed using the Cochran's Q test and I-squared (I) statistic. Literature search, study selection, data extraction, and quality assessment were performed by two independent reviewers.
Fifteen studies involving 557,475 participants and 57,064 diabetes mellitus cases were eligible for our analyses. Pooled analyses from included studies showed that high adherence to the DASH diet was significantly associated with a reduced risk of diabetes mellitus (RR: 0.82; 95% CI: 0.76-0.90, P < 0.001). Moreover, the dose-response meta-analysis revealed a linear trend between adherence to the DASH diet and diabetes mellitus (RR:0.99; 95%CI: 0.97-1.02, P = 0.546, P = 0.701). Subgroup analyses further revealed a significant inverse association between adherence to the DASH diet and diabetes mellitus risk in case-control studies (RR: 0.65; 95%CI: 0.29-1.43, P < 0.001), with a marginal inverse association in cohort studies (RR:0.83; 95%CI: 0.76-0.91, P < 0.001). Additionally, we conducted analyses separately by comparison and found a significant inverse association between DASH diet and diabetes mellitus risk in T3 vs T1 comparison studies (RR = 0.74; 95%CI: 0.64-0.86, P = 0.012).
The findings of this study demonstrate a protective association between adherence to the DASH diet and risk of diabetes mellitus. However, further prospective cohort studies and randomized controlled trials are needed to validate these findings.
尽管有几项流行病学研究报告称，坚持膳食方法防治高血压（DASH）饮食与糖尿病风险之间存在显著关联，但结果仍存在争议。在本系统评价和荟萃分析中，我们旨在总结已发表的观察性研究的现有证据，并评估 DASH 饮食依从性与糖尿病风险之间的剂量-反应关系。
我们使用 PubMed、Embase、Scopus 和中国知网（CNKI）的电子数据库，对截至 2023 年 9 月的相关文章进行了系统检索。对于 DASH 评分最高与最低类别与糖尿病风险之间的关系，我们采用随机效应模型计算了合并的相对风险（RR）及其 95%置信区间（CI）。采用 Cochran's Q 检验和 I 平方（I）统计量评估纳入研究的异质性。由两名独立的评审员进行文献检索、研究选择、数据提取和质量评估。
有 15 项研究共纳入 557475 名参与者和 57064 例糖尿病病例，符合我们的分析条件。纳入研究的汇总分析显示，高度依从 DASH 饮食与糖尿病风险降低显著相关（RR：0.82；95%CI：0.76-0.90，P<0.001）。此外，剂量-反应荟萃分析显示，DASH 饮食依从性与糖尿病之间存在线性趋势（RR：0.99；95%CI：0.97-1.02，P=0.546，P=0.701）。亚组分析进一步表明，病例对照研究中 DASH 饮食与糖尿病风险之间存在显著的负相关（RR：0.65；95%CI：0.29-1.43，P<0.001），而队列研究中存在边缘负相关（RR：0.83；95%CI：0.76-0.91，P<0.001）。此外，我们按比较进行了单独分析，发现 T3 与 T1 比较研究中 DASH 饮食与糖尿病风险之间存在显著的负相关（RR=0.74；95%CI：0.64-0.86，P=0.012）。
本研究结果表明，DASH 饮食依从性与糖尿病风险之间存在保护关联。然而，需要进一步的前瞻性队列研究和随机对照试验来验证这些发现。
