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.

CIBER Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos 3 28029 Madrid Spain Human Nutrition Unit Biochemistry and Biotechnology Department Sant Joan de Reus University Hospital IISPV Universitat Rovira i Virgili 43201 Reus Spain

Department of Nutritional Sciences Faculty of Medicine University of Toronto Toronto ON M5S 1A1 Canada Clinical Nutrition and Risk Factor Modification Center St Michael's Hospital Toronto ON M5B 1W8 Canada Toronto 3D Knowledge Synthesis and Clinical Trials Unit St Michael's Hospital Toronto ON M5B 1W8 Canada Division of Nutrition and Dietetics College of Pharmacy and Nutrition University of Saskatchewan Saskatoon SK S7N 5B5 Canada

Department of Nutritional Sciences Faculty of Medicine University of Toronto Toronto ON M5S 1A1 Canada Clinical Nutrition and Risk Factor Modification Center St Michael's Hospital Toronto ON M5B 1W8 Canada Toronto 3D Knowledge Synthesis and Clinical Trials Unit St Michael's Hospital Toronto ON M5B 1W8 Canada Li Ka Shing Knowledge Institute St Michael's Hospital Toronto ON M5B 1T8 Canada Division of Endocrinology and Metabolism St Michael's Hospital Toronto ON M5B 1W8 Canada

Physicians Committee for Responsible Medicine Washington DC 20016 USA

Physicians Committee for Responsible Medicine Washington DC 20016 USA Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Vuk Vrhovac University Clinic for Diabetes Endocrinology and Metabolic Diseases Merkur University Hospital Zagreb 10000 Croatia University of Zagreb School of Medicine Zagreb 10000 Croatia

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