Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission

被引:118
作者
Churuangsuk, Chaitong [1 ,2 ]
Hall, Julien [1 ]
Reynolds, Andrew [3 ,4 ]
Griffin, Simon J. [5 ,6 ]
Combet, Emilie [1 ]
Lean, Michael E. J. [1 ,4 ]
机构
[1] Univ Glasgow, Sch Med Dent & Nursing, Coll Med, Human Nutr, Glasgow, Lanark, Scotland
[2] Prince Songkla Univ, Fac Med, Div Internal Med, Hat Yai, Thailand
[3] Univ Otago, Dept Med, Dunedin, New Zealand
[4] Univ Otago, Edgar Natl Ctr Diabet & Obes Res, Dunedin, New Zealand
[5] Univ Cambridge, Sch Clin Med, Inst Metab Sci, MRC Epidemiol Unit, Cambridge, England
[6] Univ Cambridge, Sch Clin Med, Dept Publ Hlth & Primary Care, Primary Care Unit, Cambridge, England
基金
英国医学研究理事会;
关键词
Diet; Evidence-based guidelines; Informed clinical practice; Meta-analysis; Quality assessment; Randomised trial; Remission; Systematic review; Type; 2; diabetes; Weight loss; LIFE-STYLE INTERVENTION; LOW-CARBOHYDRATE-DIET; LOW-CALORIE DIET; RANDOMIZED CONTROLLED-TRIALS; GLYCEMIC CONTROL; RESTRICTED DIETS; OPEN-LABEL; ASSOCIATION; MORTALITY; PANCREAS;
D O I
10.1007/s00125-021-05577-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims/hypothesis Weight reduction is fundamental for type 2 diabetes management and remission, but uncertainty exists over which diet type is best to achieve and maintain weight loss. We evaluated dietary approaches for weight loss, and remission, in people with type 2 diabetes to inform practice and clinical guidelines. Methods First, we conducted a systematic review of published meta-analyses of RCTs of weight-loss diets. We searched MEDLINE (Ovid), PubMed, Web of Science and Cochrane Database of Systematic Reviews, up to 7 May 2021. We synthesised weight loss findings stratified by diet types and assessed meta-analyses quality with A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. We assessed certainty of pooled results of each meta-analysis using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (PROSPERO CRD42020169258). Second, we conducted a systematic review of any intervention studies reporting type 2 diabetes remission with weight-loss diets, in MEDLINE (via PubMed), Embase and Cochrane Central Register of Controlled Trials, up to 10 May 2021. Findings were synthesised by diet type and study quality (Cochrane Risk of Bias tool 2.0 and Risk Of Bias In Non-randomised Studies - of Interventions [ROBINS-I]), with GRADE applied (PROSPERO CRD42020208878). Results We identified 19 meta-analyses of weight-loss diets, involving 2-23 primary trials (n = 100-1587), published 2013-2021. Twelve were 'critically low' or 'low' AMSTAR 2 quality, with seven 'high' quality. Greatest weight loss was reported with very low energy diets, 1.7-2.1 MJ/day (400-500 kcal) for 8-12 weeks (high-quality meta-analysis, GRADE low), achieving 6.6 kg (95% CI -9.5, -3.7) greater weight loss than low-energy diets (4.2-6.3 MJ/day [1000-1500 kcal]). Formula meal replacements (high quality, GRADE moderate) achieved 2.4 kg (95% CI -3.3, -1.4) greater weight loss over 12-52 weeks. Low-carbohydrate diets were no better for weight loss than higher-carbohydrate/low-fat diets (high quality, GRADE high). High-protein, Mediterranean, high-monounsaturated-fatty-acid, vegetarian and low-glycaemic-index diets all achieved minimal (0.3-2 kg) or no difference from control diets (low to critically low quality, GRADE very low/moderate). For type 2 diabetes remission, of 373 records, 16 met inclusion criteria. Remissions at 1 year were reported for a median 54% of participants in RCTs including initial low-energy total diet replacement (low-risk-of-bias study, GRADE high), and 11% and 15% for meal replacements and Mediterranean diets, respectively (some concerns for risk of bias in studies, GRADE moderate/low). For ketogenic/very low-carbohydrate and very low-energy food-based diets, the evidence for remission (20% and 22%, respectively) has serious and critical risk of bias, and GRADE certainty is very low. Conclusions/interpretation Published meta-analyses of hypocaloric diets for weight management in people with type 2 diabetes do not support any particular macronutrient profile or style over others. Very low energy diets and formula meal replacement appear the most effective approaches, generally providing less energy than self-administered food-based diets. Programmes including a hypocaloric formula 'total diet replacement' induction phase were most effective for type 2 diabetes remission. Most of the evidence is restricted to 1 year or less.
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页码:14 / 36
页数:23
相关论文
共 105 条
[1]   Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes [J].
Ajala, Olubukola ;
English, Patrick ;
Pinkney, Jonathan .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 2013, 97 (03) :505-516
[2]   2-year remission of type 2 diabetes and pancreas morphology: a post-hoc analysis of the DiRECT open-label, cluster-randomised trial [J].
Al-Mrabeh, Ahmad ;
Hollingsworth, Kieren G. ;
Shaw, James A. M. ;
McConnachie, Alex ;
Sattar, Naveed ;
Lean, Michael E. J. ;
Taylor, Roy .
LANCET DIABETES & ENDOCRINOLOGY, 2020, 8 (12) :939-948
[5]   GM-CSF (granulocyte macrophage colony-stimulating factor) supplementation in culture media for women undergoing assisted reproduction [J].
Armstrong, Sarah ;
MacKenzie, Jeanette ;
Woodward, Bryan ;
Pacey, Allan ;
Farquhar, Cindy .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2020, (07)
[6]   Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial [J].
Athinarayanan, Shaminie J. ;
Adams, Rebecca N. ;
Hallberg, Sarah J. ;
McKenzie, Amy L. ;
Bhanpuri, Nasir H. ;
Campbell, Wayne W. ;
Volek, Jeff S. ;
Phinney, Stephen D. ;
McCarter, James P. .
FRONTIERS IN ENDOCRINOLOGY, 2019, 10
[7]   A four-stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations [J].
Bhopal, R. S. .
DIABETIC MEDICINE, 2013, 30 (01) :35-42
[8]   How Do We Define Cure of Diabetes? [J].
Buse, John B. ;
Caprio, Sonia ;
Cefalu, William T. ;
Ceriello, Antonio ;
Del Prato, Stefano ;
Inzucchi, Silvio E. ;
McLaughlin, Sue ;
Phillips, Gordon L., II ;
Robertson, R. Paul ;
Rubino, Francesco ;
Kahn, Richard ;
Kirkman, M. Sue .
DIABETES CARE, 2009, 32 (11) :2133-2135
[9]   Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low-calorie liquid diet-based intervention in Barbados [J].
Bynoe, K. ;
Unwin, N. ;
Taylor, C. ;
Murphy, M. M. ;
Bartholomew, L. ;
Greenidge, A. ;
Abed, M. ;
Jeyaseelan, S. ;
Cobelli, C. ;
Dalla Man, C. ;
Taylor, R. .
DIABETIC MEDICINE, 2020, 37 (11) :1816-1824
[10]   Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline [J].
Campbell, Mhairi ;
McKenzie, Joanne E. ;
Sowden, Amanda ;
Katikireddi, Srinivasa Vittal ;
Brennan, Sue E. ;
Ellis, Simon ;
Hartmann-Boyce, Jamie ;
Ryan, Rebecca ;
Shepperd, Sasha ;
Thomas, James ;
Welch, Vivian ;
Thomson, Hilary .
BMJ-BRITISH MEDICAL JOURNAL, 2020, 368