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Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials.
Clin Nutr. 2019 06; 38(3):1133-1145.CN

Abstract

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 HbA1c. 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 (I[2] 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 HbA1c (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% CI: -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.

Authors+Show Affiliations

Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic; Physicians Committee for Responsible Medicine, Washington, DC, USA.Department of Endocrinology, Diabetes and Metabolic Diseases, Dubrava University Hospital, Zagreb, Croatia.CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Electronic address: john.sievenpiper@utoronto.ca.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

29960809

Citation

Viguiliouk, Effie, et al. "Effect of Vegetarian Dietary Patterns On Cardiometabolic Risk Factors in Diabetes: a Systematic Review and Meta-analysis of Randomized Controlled Trials." Clinical Nutrition (Edinburgh, Scotland), vol. 38, no. 3, 2019, pp. 1133-1145.
Viguiliouk E, Kendall CW, Kahleová H, et al. Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2019;38(3):1133-1145.
Viguiliouk, E., Kendall, C. W., Kahleová, H., Rahelić, D., Salas-Salvadó, J., Choo, V. L., Mejia, S. B., Stewart, S. E., Leiter, L. A., Jenkins, D. J., & Sievenpiper, J. L. (2019). Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition (Edinburgh, Scotland), 38(3), 1133-1145. https://doi.org/10.1016/j.clnu.2018.05.032
Viguiliouk E, et al. Effect of Vegetarian Dietary Patterns On Cardiometabolic Risk Factors in Diabetes: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Nutr. 2019;38(3):1133-1145. PubMed PMID: 29960809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials. AU - Viguiliouk,Effie, AU - Kendall,Cyril Wc, AU - Kahleová,Hana, AU - Rahelić,Dario, AU - Salas-Salvadó,Jordi, AU - Choo,Vivian L, AU - Mejia,Sonia Blanco, AU - Stewart,Sarah E, AU - Leiter,Lawrence A, AU - Jenkins,David Ja, AU - Sievenpiper,John L, Y1 - 2018/06/13/ PY - 2017/12/07/received PY - 2018/05/27/revised PY - 2018/05/31/accepted PY - 2018/7/2/pubmed PY - 2020/5/29/medline PY - 2018/7/2/entrez KW - Cardiometabolic risk KW - Diabetes KW - GRADE KW - Meta-analysis KW - Systematic review KW - Vegetarian SP - 1133 EP - 1145 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 38 IS - 3 N2 - 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 HbA1c. 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 (I[2] 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 HbA1c (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% CI: -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. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/29960809/Effect_of_vegetarian_dietary_patterns_on_cardiometabolic_risk_factors_in_diabetes:_A_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ DB - PRIME DP - Unbound Medicine ER -