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The effect of alpha-linolenic acid on glycemic control in individuals with type 2 diabetes: A systematic review and meta-analysis of randomized controlled clinical trials.
Medicine (Baltimore). 2017 May; 96(21):e6531.M

Abstract

BACKGROUND

Polyunsaturated fats (PUFAs) have been shown to reduce type 2 diabetes (T2DM) risk and improve insulin responsiveness in T2DM subjects, but whether the plant sources of omega-3 PUFA (alpha-linolenic acid [ALA]) have an effect on glycemic control requires further investigation.

METHODS

The parameters of interest were glycated hemoglobin (HbA1c), fasting blood glucose (FBG), fasting blood insulin (FBI), homeostatic model assessment for insulin resistance (HOMA-IR), fructosamine, and glycated albumin. A comprehensive search was conducted with MEDLINE, Embase, CINAHL, and Cochrane. Eligible studies included randomized controlled trials (RCTs) ≥1 month in duration that compared diets enriched in ALA with usual diets on glycemic parameters. For each study, the risk of bias as well as the study quality was assessed. Using the statistical software RevMan (v5.3), data were pooled using the generic inverse method with random effects model, and final results were expressed as mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was assessed by the Cochran Q statistic and quantified by the I statistic.

RESULTS

A total of 8 trials (N = 212) were included in the meta-analysis. Compared to a control diet, a median dose of 4.4 g/day of ALA intake for a median duration of 3 months did not affect HbA1c (%) (MD = -.01; [95%: -.32, .31], P = .96). A median ALA dose of 5.4 g/day did not lower FBG (MD = .07; [95% CI: -.61, .76], P = .84) or FBI (MD = 7.03, [95% CI: -5.84, 19.89], P = .28). Summary effect estimates were generally compromised by considerable and unexplained heterogeneity (I ≥75%). In the subgroup analysis of continuous predictors, a reduction in HbA1c (%) and FBG (mmol/L) was significantly associated with an increased intake of ALA. Further adjustment for Publication Bias using Duval and Tweedie's trim-and-fill analysis provided an adjusted, significant MD of -.25 (95% CI: -.38, -.12; P <.001) for HbA1c (%).

CONCLUSIONS

ALA-enriched diets did not affect HbA1c, FBG, or FBI. The scarce number of existing RCTs and the presence of heterogeneity in our meta-analysis limit the ability to make firm conclusions about ALA in T2DM management. The potential for ALA to have dose-dependent effects warrants further research in this area.

Authors+Show Affiliations

Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada Brazil Department of Pharmacology and Therapeutic, State University of Maringa, Maringa, Brazil Toronto 3D Knowledge Synthesis and Clinical Trials Unit Li Ka Shing Knowledge Institute Division of Endocrinology & Medicine, St. Michael's Hospital, Toronto Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada Clinic for Diabetes, Endocrinology and Metabolic Diseases Vuk Vrhovac, University Hospital Merkur, University of Zagreb, School of Medicine, Zagreb, Croatia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28538363

Citation

Jovanovski, Elena, et al. "The Effect of Alpha-linolenic Acid On Glycemic Control in Individuals With Type 2 Diabetes: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials." Medicine, vol. 96, no. 21, 2017, pp. e6531.
Jovanovski E, Li D, Thanh Ho HV, et al. The effect of alpha-linolenic acid on glycemic control in individuals with type 2 diabetes: A systematic review and meta-analysis of randomized controlled clinical trials. Medicine (Baltimore). 2017;96(21):e6531.
Jovanovski, E., Li, D., Thanh Ho, H. V., Djedovic, V., Ruiz Marques, A. C., Shishtar, E., Mejia, S. B., Sievenpiper, J. L., de Souza, R. J., Duvnjak, L., & Vuksan, V. (2017). The effect of alpha-linolenic acid on glycemic control in individuals with type 2 diabetes: A systematic review and meta-analysis of randomized controlled clinical trials. Medicine, 96(21), e6531. https://doi.org/10.1097/MD.0000000000006531
Jovanovski E, et al. The Effect of Alpha-linolenic Acid On Glycemic Control in Individuals With Type 2 Diabetes: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials. Medicine (Baltimore). 2017;96(21):e6531. PubMed PMID: 28538363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of alpha-linolenic acid on glycemic control in individuals with type 2 diabetes: A systematic review and meta-analysis of randomized controlled clinical trials. AU - Jovanovski,Elena, AU - Li,Dandan, AU - Thanh Ho,Hoang Vi, AU - Djedovic,Vladimir, AU - Ruiz Marques,Any de Castro, AU - Shishtar,Esra, AU - Mejia,Sonia Blanco, AU - Sievenpiper,John L, AU - de Souza,Russell J, AU - Duvnjak,Lea, AU - Vuksan,Vladimir, PY - 2017/5/25/entrez PY - 2017/5/26/pubmed PY - 2017/6/27/medline SP - e6531 EP - e6531 JF - Medicine JO - Medicine (Baltimore) VL - 96 IS - 21 N2 - BACKGROUND: Polyunsaturated fats (PUFAs) have been shown to reduce type 2 diabetes (T2DM) risk and improve insulin responsiveness in T2DM subjects, but whether the plant sources of omega-3 PUFA (alpha-linolenic acid [ALA]) have an effect on glycemic control requires further investigation. METHODS: The parameters of interest were glycated hemoglobin (HbA1c), fasting blood glucose (FBG), fasting blood insulin (FBI), homeostatic model assessment for insulin resistance (HOMA-IR), fructosamine, and glycated albumin. A comprehensive search was conducted with MEDLINE, Embase, CINAHL, and Cochrane. Eligible studies included randomized controlled trials (RCTs) ≥1 month in duration that compared diets enriched in ALA with usual diets on glycemic parameters. For each study, the risk of bias as well as the study quality was assessed. Using the statistical software RevMan (v5.3), data were pooled using the generic inverse method with random effects model, and final results were expressed as mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was assessed by the Cochran Q statistic and quantified by the I statistic. RESULTS: A total of 8 trials (N = 212) were included in the meta-analysis. Compared to a control diet, a median dose of 4.4 g/day of ALA intake for a median duration of 3 months did not affect HbA1c (%) (MD = -.01; [95%: -.32, .31], P = .96). A median ALA dose of 5.4 g/day did not lower FBG (MD = .07; [95% CI: -.61, .76], P = .84) or FBI (MD = 7.03, [95% CI: -5.84, 19.89], P = .28). Summary effect estimates were generally compromised by considerable and unexplained heterogeneity (I ≥75%). In the subgroup analysis of continuous predictors, a reduction in HbA1c (%) and FBG (mmol/L) was significantly associated with an increased intake of ALA. Further adjustment for Publication Bias using Duval and Tweedie's trim-and-fill analysis provided an adjusted, significant MD of -.25 (95% CI: -.38, -.12; P <.001) for HbA1c (%). CONCLUSIONS: ALA-enriched diets did not affect HbA1c, FBG, or FBI. The scarce number of existing RCTs and the presence of heterogeneity in our meta-analysis limit the ability to make firm conclusions about ALA in T2DM management. The potential for ALA to have dose-dependent effects warrants further research in this area. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/28538363/The_effect_of_alpha_linolenic_acid_on_glycemic_control_in_individuals_with_type_2_diabetes:_A_systematic_review_and_meta_analysis_of_randomized_controlled_clinical_trials_ L2 - https://doi.org/10.1097/MD.0000000000006531 DB - PRIME DP - Unbound Medicine ER -