总体、健康和不健康的植物性饮食指数与糖尿病前期和2型糖尿病风险之间的关联：前瞻性研究的系统评价和剂量反应荟萃分析

The Association Between Overall, Healthy, and Unhealthy Plant-Based Diet Index and Risk of Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies.

作者信息

Nikparast Ali, Mirzaei Parmis, Tadayoni Zeinab S, Asghari Golaleh

机构信息

Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Faculty of Nutrition Science and Food Technology, Department of Clinical Nutrition & Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

Nutr Rev. 2025 Feb 1;83(2):e157-e177. doi: 10.1093/nutrit/nuae049.

DOI:10.1093/nutrit/nuae049

PMID:38796844

Abstract

CONTEXT

The global incidence of prediabetes and type 2 diabetes mellitus (T2DM) has increased substantially in recent years. Among the established, modifiable lifestyle factors associated with favorable prediabetes and T2DM risk, healthy dietary patterns have attracted considerable attention.

OBJECTIVE

The association between adherence to plant-based dietary pattern indices (PDIs), including the overall PDI (O-PDI), healthy PDI (H-PDI), and unhealthy PDI (U-PDI), and the risk of prediabetes and T2DM was investigated in this study.

DATA SOURCES

A literature search was conducted of the PubMed/Medline, Scopus, and Web of Sciences databases from their inception to February 2024. A systematic review and meta-analysis were conducted using random effects models and dose-response analyses. The Cochran Q test and the I2 statistic were used to evaluate heterogeneity between studies.

DATA EXTRACTION

A total of 16 publications, with data on a total of 721 012 participants, were identified for the meta-analysis.

DATA ANALYSIS

According to a pooled analysis, compared with the lowest category of O-PDI and H-PDI adherence, the highest category was associated with a 14% and 19% reduction in T2DM risk, respectively, for O-PDI (effect size [ES] = 0.86; 95%CI, 0.82-0.90; I2 = 57.7) and H-PDI (ES = 0.81; 95%CI, 0.75-0.88; I2 = 82.6). Greater adherence to U-PDI was significantly associated with an 10% increase in the risk of T2DM (ES = 1.10; 95%CI, 1.04-1.16). Consistent associations were found within the predetermined subgroups. As well, there was a nonlinear inverse association between O-PDI, H-PDI, and T2DM risk. No significant association was found between adherence to O-PDI (ES = 0.87; 95%CI, 0.75-1.01; I2 = 68%), H-PDI (ES = 0.99; 95%CI, 0.87-1.13; I2 = 0.0%), and U-PDI (ES = 1.09; 95%CI, 0.94-1.21; I2 = 22.9%) and risk of prediabetes.

CONCLUSION

These findings underscore the importance of dietary selections within the framework of a plant-based dietary pattern, particularly when incorporating healthful, plant-based foods, which may have potential benefits in reducing the T2DM risk.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023459851.

摘要

背景

近年来，全球糖尿病前期和2型糖尿病（T2DM）的发病率大幅上升。在已确定的、与糖尿病前期和T2DM风险有利相关的可改变生活方式因素中，健康的饮食模式受到了相当多的关注。

目的

本研究调查了遵循以植物为基础的饮食模式指数（PDIs），包括总体PDI（O-PDI）、健康PDI（H-PDI）和不健康PDI（U-PDI），与糖尿病前期和T2DM风险之间的关联。

数据来源

对PubMed/Medline、Scopus和Web of Sciences数据库从创建到2024年2月进行了文献检索。使用随机效应模型和剂量反应分析进行了系统评价和荟萃分析。采用Cochran Q检验和I²统计量评估研究间的异质性。

数据提取

共确定了16篇出版物，纳入荟萃分析的数据来自721012名参与者。

数据分析

根据汇总分析，与O-PDI和H-PDI依从性最低类别相比，最高类别分别与T2DM风险降低14%和19%相关，O-PDI（效应量[ES]=0.86；95%CI，0.82-0.90；I²=57.7）和H-PDI（ES=0.81；95%CI，0.75-0.88；I²=82.6）。更高的U-PDI依从性与T2DM风险显著增加10%相关（ES=1.10；95%CI，1.04-1.16）。在预定亚组中发现了一致的关联。此外，O-PDI、H-PDI与T2DM风险之间存在非线性负相关。未发现O-PDI（ES=0.87；95%CI，0.75-1.01；I²=68%）、H-PDI（ES=0.99；95%CI，0.87-1.13；I²=0.0%）和U-PDI（ES=1.09；95%CI，0.94-1.21；I²=22.9%）的依从性与糖尿病前期风险之间存在显著关联。