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低碳水化合物饮食对超重或肥胖2型糖尿病患者糖脂代谢的影响:一项随机对照试验的荟萃分析

The effects of low-carbohydrate diet on glucose and lipid metabolism in overweight or obese patients with T2DM: a meta-analysis of randomized controlled trials.

作者信息

Tian Wende, Cao Shuyu, Guan Yongxin, Zhang Zihao, Liu Qiyu, Ju Jianqing, Xi Ruixi, Bai Ruina

机构信息

National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

Changping Traditional Chinese Medicine Hospital, Beijing, China.

出版信息

Front Nutr. 2025 Jan 6;11:1516086. doi: 10.3389/fnut.2024.1516086. eCollection 2024.

Abstract

BACKGROUND

The dual burden of Type 2 Diabetes Mellitus (T2DM) and obesity is a critical public health issue. Low-carbohydrate diets have emerged as a potential intervention, yet clinical evidence remains inconclusive.

PURPOSE

This meta-analysis assesses the impact of low-carbohydrate diets on metabolic profiles in overweight or obese T2DM patients, aiming to guide clinical practice.

METHODS

A systematic review identified randomized clinical trials (RCTs) comparing low-carbohydrate diets to control diets in T2DM patients from PubMed, Embase, and the Cochrane Library databases up to April 2023.

RESULTS

Seventeen RCTs, encompassing 1,197 participants, demonstrated that low-carbohydrate diets significantly improved HbA1c levels and fasting plasma glucose (mean difference [MD] = -0.36, 95% CI -0.44 to -0.29,  < 0.00001; MD = -10.71, 95% CI -14.39 to -7.03,  < 0.00001). They also reduced triglycerides and increased HDL cholesterol (MD = -19.91, 95% CI -28.83 to -10.99,  < 0.00001; MD = 2.49, 95% CI 1.07-3.91,  = 0.0006), without affecting LDL and total cholesterol. Weight loss, reduced BMI, lower diastolic blood pressure, and decreased waist circumference were additional benefits.

CONCLUSION

Low-carbohydrate diets may enhance glycemic control and lipid profiles in overweight or obese T2DM patients, warranting consideration in T2DM management. However, the variability in diet definitions and methodologies underscores the necessity for further research to standardize dietary guidelines and evaluate long-term effects.

摘要

背景

2型糖尿病(T2DM)和肥胖的双重负担是一个关键的公共卫生问题。低碳水化合物饮食已成为一种潜在的干预措施,但临床证据仍不确凿。

目的

本荟萃分析评估低碳水化合物饮食对超重或肥胖T2DM患者代谢谱的影响,旨在指导临床实践。

方法

一项系统评价从截至2023年4月的PubMed、Embase和Cochrane图书馆数据库中识别出比较低碳水化合物饮食与对照饮食对T2DM患者影响的随机临床试验(RCT)。

结果

17项RCT,涵盖1197名参与者,表明低碳水化合物饮食显著改善糖化血红蛋白水平和空腹血糖(平均差值[MD]=-0.36,95%置信区间-0.44至-0.29,P<0.00001;MD=-10.71,95%置信区间-14.39至-7.03,P<0.00001)。它们还降低了甘油三酯并增加了高密度脂蛋白胆固醇(MD=-19.91,95%置信区间-28.83至-10.99,P<0.00001;MD=2.49,95%置信区间1.07 - 3.91,P=0.0006),而不影响低密度脂蛋白和总胆固醇。体重减轻、体重指数降低、舒张压降低和腰围减小是额外的益处。

结论

低碳水化合物饮食可能改善超重或肥胖T2DM患者的血糖控制和血脂状况,在T2DM管理中值得考虑。然而,饮食定义和方法的变异性强调了进一步研究以规范饮食指南和评估长期影响的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8dde/11743357/bf66c5e11048/fnut-11-1516086-g001.jpg

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本文引用的文献

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Low-carbohydrate diets in East Asians with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.
J Diabetes Investig. 2024 Dec;15(12):1753-1762. doi: 10.1111/jdi.14326. Epub 2024 Oct 3.
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Diabetes Res Clin Pract. 2024 Nov;217:111844. doi: 10.1016/j.diabres.2024.111844. Epub 2024 Sep 3.
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Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c: A Randomized Clinical Trial.
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Children (Basel). 2022 Sep 10;9(9):1372. doi: 10.3390/children9091372.
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