Journal
CLINICAL NUTRITION
Volume 38, Issue 3, Pages 1133-1145Publisher
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.clnu.2018.05.032
Keywords
Vegetarian; Cardiometabolic risk; Diabetes; Systematic review; Meta-analysis; GRADE
Categories
Funding
- Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD)
- Canadian Institutes of Health Research through the Canada-wide Human Nutrition Trialists' Network (NTN) [129920]
- Diet, Digestive tract, and Disease (3-D) Centre through the Canada Foundation for Innovation (CFI)
- Toronto 3D Knowledge Synthesis and Clinical Trials foundation Internship Award
- Government of Canada through the Canada Research Chair Endowment
- PSI Graham Farquharson Knowledge Translation Fellowship
- Canadian Diabetes Association Clinician Scientist award
- Banting & Best Diabetes Centre Sun Life Financial New Investigator Award
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Background & aims: To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of randomized controlled trials to summarize the evidence for the effect of vegetarian dietary patterns on glycemic control and other established cardiometabolic risk factors in individuals with diabetes. Methods: We searched MEDLINE, EMBASE, and Cochrane databases through February 26, 2018 for randomized controlled trials >= 3 weeks assessing the effect of vegetarian dietary patterns in individuals with diabetes. The primary outcome was HbA(1c). Secondary outcomes included other markers of glycemic control, blood lipids, body weight/adiposity, and blood pressure. Two independent reviewers extracted data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (12 statistic). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Nine trials (n = 664 participants) met the eligibility criteria. Vegetarian dietary patterns significantly lowered HbA(1c) (MD = -0.29% [95% CI: -0.45, -0.12%]), fasting glucose (MD = -0.56 mmol/L [95% CI: -0.99, -0.13 mmol/L]), LDL-C (MD = -0.12 mmol/L [95% Cl: -0.20, -0.04 mmol/L]), non-HDL-C (MD = -0.13 mmol/L [95% CI: -0.26, -0.01 mmol/L]), body weight (MD = -2.15 kg [95% CI: -2.95, -1.34 kg]), BMI (MD = -0.74 kg/m(2) [95% CI: -1.09, -0.39 kg/m(2)]) and waist circumference (MD = -2.86 cm [95% CI: -3.76, -1.96 cm]). There was no significant effect on fasting insulin, HDL-C, triglycerides or blood pressure. The overall certainty of evidence was moderate but was low for fasting insulin, triglycerides and waist circumference. Conclusion: Vegetarian dietary patterns improve glycemic control, LDL-C, non-HDL-C, and body weight/adiposity in individuals with diabetes, supporting their inclusion for diabetes management. More research is needed to improve our confidence in the estimates. ClinicalTrials.gov identifier: NCT02600377. (C) 2018 Published by Elsevier Ltd.
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