Abstract
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) conducted a review of existing systematic reviews and meta-analyses to explain the relationship between different dietary patterns and patient-important cardiometabolic outcomes. To update the clinical practice guidelines for nutrition therapy in the prevention and management of diabetes, we summarize the evidence from these evidence syntheses for the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Portfolio, Nordic, liquid meal replacement, and vegetarian dietary patterns. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. We summarized the evidence for disease incidence outcomes and risk factor outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively. The Mediterranean diet showed a cardiovascular disease (CVD) incidence (RR: 0.62; 95%CI, 0.50, 0.78), and non-significant CVD mortality (RR: 0.67; 95%CI, 0.45, 1.00) benefit. The DASH dietary pattern improved cardiometabolic risk factors (P < 0.05) and was associated with the decreased incidence of CVD (RR, 0.80; 95%CI, 0.76, 0.85). Vegetarian dietary patterns were associated with improved cardiometabolic risk factors (P < 0.05) and the reduced incidence (0.72; 95%CI: 0.61, 0.85) and mortality (RR, 0.78; 95%CI, 0.69, 0.88) of coronary heart disease. The Portfolio dietary pattern improved cardiometabolic risk factors and reduced estimated 10-year coronary heart disease (CHD) risk by 13% (−1.34% (95%CI, −2.19 to −0.49)). The Nordic dietary pattern was correlated with decreased CVD (0.93 (95%CI, 0.88, 0.99)) and stroke incidence (0.87 (95%CI, 0.77, 0.97)) and, along with liquid meal replacements, improved cardiometabolic risk factors (P < 0.05). The evidence was assessed as low to moderate certainty for most dietary patterns and outcome pairs. Current evidence suggests that the Mediterranean, DASH, Portfolio, Nordic, liquid meal replacement and vegetarian dietary patterns have cardiometabolic advantages in populations inclusive of diabetes.
Highlights
Diet-related cardiometabolic diseases, such as obesity, diabetes, and cardiovascular disease, inflict considerable implications on our health and economy [1]
The dietary patterns reviewed in this paper have broadly accepted definitions that likely vary between studies due to differences in populations
Our findings demonstrate that the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Portfolio, and vegetarian dietary patterns play valuable roles in reducing the incidence and mortality from various cardiovascular disease outcomes in individuals with and without diabetes
Summary
Diet-related cardiometabolic diseases, such as obesity, diabetes, and cardiovascular disease, inflict considerable implications on our health and economy [1]. The global incidence of chronic disease and premature death is in large part due to suboptimal nutrition [3,4]. Study 2017 assessed the health effects of dietary risks in 195 countries in 1990–2017 and estimated that 11 million deaths and 255 million disability-adjusted life-years were attributable to dietary risk factors, high intake of sodium and low intakes of whole grains and fruits [6]. Interventions modifying intermediate risk factors, such as excess body weight, dyslipidemia, hypertension, prediabetes or diabetes, as well as improving lifestyle behaviors, i.e., avoiding tobacco, engaging in regular physical activity, and eating a balanced diet, are essential to preventing and treating cardiovascular disease. Nutrition may even surpass other habits, such as physical activity and no smoking, in preventing premature cardiovascular disease death and disability [3]
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