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Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials
P. Massara, A. Zurbau, AJ. Glenn, L. Chiavaroli, TA. Khan, E. Viguiliouk, SB. Mejia, EM. Comelli, V. Chen, U. Schwab, U. Risérus, M. Uusitupa, AM. Aas, K. Hermansen, I. Thorsdottir, D. Rahelić, H. Kahleová, J. Salas-Salvadó, CWC. Kendall, JL. Sievenpiper
Jazyk angličtina Země Německo
Typ dokumentu metaanalýza, systematický přehled, časopisecké články, práce podpořená grantem
Grantová podpora
129920
CIHR - Canada
NLK
ProQuest Central
od 1999-01-01 do Před 1 rokem
Medline Complete (EBSCOhost)
od 2000-01-01 do Před 1 rokem
Health & Medicine (ProQuest)
od 1999-01-01 do Před 1 rokem
- MeSH
- apolipoproteiny MeSH
- cévní mozková příhoda * MeSH
- cholesterol MeSH
- diabetes mellitus 2. typu * epidemiologie MeSH
- HDL-cholesterol MeSH
- inzuliny * MeSH
- kardiovaskulární nemoci * MeSH
- LDL-cholesterol MeSH
- lidé MeSH
- obezita MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- tělesná hmotnost MeSH
- zánět MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
AIMS/HYPOTHESIS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS/INTERPRETATION: 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. REGISTRATION: ClinicalTrials.gov NCT04094194. FUNDING: Diabetes and Nutrition Study Group of the EASD Clinical Practice.
Clinical Nutrition and Risk Factor Modification Centre St Michael's Hospital Toronto ON Canada
College of Pharmacy and Nutrition University of Saskatchewan Saskatoon SK Canada
Croatian Catholic University School of Medicine Zagreb Croatia
Department of Clinical Medicine Aarhus University Aarhus Denmark
Department of Endocrinology and Internal Medicine Aarhus University Hospital Aarhus Denmark
Department of Medicine Temerty Faculty of Medicine University of Toronto Toronto ON Canada
Department of Nutrition Harvard T H Chan School of Public Health Boston MA USA
Human Nutrition Department IISPV Universitat Rovira i Virgili Reus Spain
Institute for Clinical and Experimental Medicine Diabetes Centre Prague Czech Republic
Josip Juraj Strossmayer University School of Medicine Osijek Croatia
Landspitali University Hospital of Iceland Reykjavík Iceland
Li Ka Shing Knowledge Institute St Michael's Hospital Toronto ON Canada
Physicians Committee for Responsible Medicine Washington DC USA
Toronto 3D Knowledge Synthesis and Clinical Trials Unit Toronto ON Canada
Unit for Nutrition Research Health Science Institute University of Iceland Reykjavík Iceland
Women's College Research Institute Women's College Hospital Toronto ON Canada
Citace poskytuje Crossref.org
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