健康传统北欧食品中的北欧饮食模式可能在预防和管理糖尿病中起作用。为告知EASD营养治疗临床实践指南的更新,我们对北欧饮食模式和心脏代谢结局进行了系统评价和荟萃分析.
我们搜索了MEDLINE,EMBASE和Cochrane图书馆从成立到2021年3月9日。我们纳入前瞻性队列研究和RCT,随访时间≥1年,≥3周,分别。两名独立评审员提取相关数据并评估偏倚风险(纽卡斯尔-渥太华量表和Cochrane偏倚风险工具)。主要结果是前瞻性队列研究中的总CVD发生率和RCT中的LDL-胆固醇。前瞻性队列研究的次要结局是CVD死亡率,冠心病发病率和死亡率,中风发病率和死亡率,和2型糖尿病发病率;在随机对照试验中,次要结局是其他既定的脂质目标(非HDL-胆固醇,载脂蛋白B,HDL-胆固醇,甘油三酯),血糖控制标志物(HbA1c,空腹血糖,空腹胰岛素),肥胖(体重,BMI,腰围)和炎症(C反应蛋白),和血压(收缩压和舒张压)。建议的分级,评估,使用开发和评估(GRADE)方法来评估证据的确定性。
我们纳入了15项独特的前瞻性队列研究(n=1,057,176,41,708例心血管事件和13,121例糖尿病病例),其中糖尿病患者用于评估心血管结局,非糖尿病患者用于评估糖尿病发病率。和6项RCT(n=717)在有一个或多个糖尿病危险因素的人群中。在前瞻性队列研究中,对北欧饮食模式的更高依从性与主要结局的“小的重要”减少有关,总CVD发生率(最高和最低依从性的RR:0.93[95%CI0.88,0.99],p=0.01;实质性异质性:I2=88%,PQ<0.001),心血管疾病死亡率和冠心病发病率的次要结局降低相似或更大,中风和2型糖尿病(p<0.05)。观察到总CVD发生率的剂量-反应梯度相反,CVD死亡率和冠心病发病率,中风和2型糖尿病(p<0.05)。没有研究评估冠心病或卒中死亡率。在RCT中,LDL-胆固醇有小的重要降低(平均差异[MD]-0.26mmol/l[95%CI-0.52,-0.00],pMD=0.05;实质性异质性:I2=89%,PQ<0.01),以及非HDL-胆固醇次要结局的“小的重要”或更大的降低,载脂蛋白B,胰岛素,体重,BMI和收缩压(p<0.05)。对于其他结果,有“微不足道”的减少或没有影响。心血管疾病总发病率和低密度脂蛋白胆固醇的证据确定性较低;心血管疾病死亡率为中等至高,既定的脂质目标,肥胖标记,血糖控制,血压和炎症;所有其他结果都很低,证据被降级主要是因为不精确和不一致。
坚持北欧饮食模式与主要心血管疾病结局和糖尿病风险的显著降低有关。LDL-胆固醇和其他中间心脏代谢危险因素的类似降低也支持了这一点。现有证据为北欧饮食模式对糖尿病患者或有糖尿病风险的人的可能益处提供了普遍的良好指示。
ClinicalTrials.govNCT04094194。
EASD临床实践的糖尿病和营养研究小组。
Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic
review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes.
We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle-Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence.
We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with \'small important\' reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQ<0.001), and similar or greater reductions in the secondary outcomes of CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). Inverse dose-response gradients were seen for total CVD incidence, CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] -0.26 mmol/l [95% CI -0.52, -0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQ<0.01), and \'small important\' or greater reductions in the secondary outcomes of non-HDL-cholesterol, apolipoprotein B, insulin, body weight, BMI and systolic blood pressure (p<0.05). For the other outcomes there were \'trivial\' reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency.
Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes.
ClinicalTrials.gov NCT04094194.
Diabetes and Nutrition Study Group of the EASD Clinical Practice.