不同宏量营养素组成对2型糖尿病管理的比较效果：一项随机试验的系统评价和网状Meta分析

Comparative effects of different macronutrient compositions for type 2 diabetes management: a systematic review and network meta-analysis of randomized trials.

作者信息

Badrooj Negin, Jayedi Ahmad, Shab-Bidar Sakineh

机构信息

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Tehran, Iran.

Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.

出版信息

J Health Popul Nutr. 2025 Apr 8;44(1):108. doi: 10.1186/s41043-025-00818-1.

DOI:10.1186/s41043-025-00818-1

PMID:40200364

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11977911/

Abstract

BACKGROUND

To assess and rank the comparative effects of different exact macronutrient compositions for type 2 diabetes management rather than examining single macronutrients or as a dietary pattern.

METHODS

PubMed, Scopus, and Cochrane Library Central Register of Controlled Trials were searched. Randomized controlled trials were included. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95% credible intervals (CrIs). The certainty of evidence was rated using the GRADE approach.

RESULTS

80 trials with 9232 patients with type 2 diabetes were included in the network meta-analysis. A very low-carbohydrate, high-protein, and calorie-restricted diet had the greatest effect on reducing HbA (range of mean difference: - 1.0% to - 1.79%), weight (range of mean difference: -5.83 kg to -10.96 kg), and FPG (range of mean difference: - 2.20 mmol/L to - 2.88 mmol/L) at 6-month follow-up, but at 12-month follow-up, the effect remained only for HbA (range of mean difference: - 1.25% to - 1.30%) and FPG (range of mean difference: - 1.21 mmol/L to - 1.27 mmol/L). For weight loss in 12-month follow-up, the low-carbohydrate, high-protein diet was probably the most effective approach (range of mean difference: - 10.05 kg to - 14.52 kg). The best dietary approach to reduce LDL at 6-month follow-up was a low carbohydrate, high protein, calorie-restricted diet (range of mean difference: - 0.49 mmol/L to - 0.59 mmol/L) and at 12-month follow-up, a moderate carbohydrate, standard protein, calorie-restricted diet was effective in reducing LDL (mean difference: - 0.87 mmol/L, 95%CrI - 1.55 to - 0.16).

CONCLUSIONS

A very low carbohydrate, high protein, calorie-restricted diet can be an effective dietary composition in managing diabetes, but milder dietary carbohydrate restriction for weight loss in the long-term, and improving lipid profiles is needed.

摘要

背景

评估并排序不同精确宏量营养素组成对2型糖尿病管理的比较效果，而非研究单一宏量营养素或作为一种饮食模式。

方法

检索了PubMed、Scopus和Cochrane图书馆对照试验中央注册库。纳入随机对照试验。采用贝叶斯框架进行随机效应网络荟萃分析，以计算平均差（MD）和95%可信区间（CrI）。使用GRADE方法对证据的确定性进行评级。

结果

网络荟萃分析纳入了80项试验，共9232例2型糖尿病患者。在6个月随访时，极低碳水化合物、高蛋白和热量限制饮食对降低糖化血红蛋白（平均差范围：-1.0%至-1.79%）、体重（平均差范围：-5.83 kg至-10.96 kg）和空腹血糖（平均差范围：-2.20 mmol/L至-2.88 mmol/L）的效果最佳，但在12个月随访时，效果仅在糖化血红蛋白（平均差范围：-1.25%至-1.30%）和空腹血糖（平均差范围：-1.21 mmol/L至-1.27 mmol/L）方面仍然存在。对于12个月随访时的体重减轻，低碳水化合物、高蛋白饮食可能是最有效的方法（平均差范围：-10.05 kg至-14.52 kg）。在6个月随访时，降低低密度脂蛋白的最佳饮食方法是低碳水化合物、高蛋白、热量限制饮食（平均差范围：-0.49 mmol/L至-0.59 mmol/L），在12个月随访时，中等碳水化合物、标准蛋白质、热量限制饮食对降低低密度脂蛋白有效（平均差：-0.87 mmol/L，95%CrI -1.55至-0.16）。