Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials
Abstract
Background & aims To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of randomized controlled trials to summarize the evidence for the effect of vegetarian dietary patterns on glycemic control and other established cardiometabolic risk factors in individuals with diabetes.Methods We searched MEDLINE, EMBASE, and Cochrane databases through February 26, 2018 for randomized controlled trials ≥3 weeks assessing the effect of vegetarian dietary patterns in individuals with diabetes. The primary outcome was HbA 1c. Secondary outcomes included other markers of glycemic control, blood lipids, body weight/adiposity, and blood pressure. Two independent reviewers extracted data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Results Nine trials (n = 664 participants) met the eligibility criteria. Vegetarian dietary patterns significantly lowered HbA 1c (MD = -0.29% [95% CI: -0.45, -0.12%]), fasting glucose (MD = -0.56 mmol/L [95% CI: -0.99, -0.13 mmol/L]), LDL-C (MD = -0.12 mmol/L [95% CI: -0.20, -0.04 mmol/L]), non-HDL-C (MD = -0.13 mmol/L [95% CI: -0.26, -0.01 mmol/L]), body weight (MD = -2.15 kg [95% CI: -2.95, -1.34 kg]), BMI (MD = -0.74 kg/m 2 [95% CI: -1.09, -0.39 kg/m 2]) and waist circumference (MD = -2.86 cm [95% CI: -3.76, -1.96 cm]). There was no significant effect on fasting insulin, HDL-C, triglycerides or blood pressure. The overall certainty of evidence was moderate but was low for fasting insulin, triglycerides and waist circumference.Conclusion Vegetarian dietary patterns improve glycemic control, LDL-C, non-HDL-C, and body weight/adiposity in individuals with diabetes, supporting their inclusion for diabetes management. More research is needed to improve our confidence in the estimates. CLINICALTRIALS.Gov identifier NCT02600377.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the Look AHEAD trial, individuals following a calorie-restricted low-fat eating pattern in a structured weight loss program using meal replacements achieved moderate success compared with the control condition eating plan.
“individuals following a calorie-restricted low-fat eating pattern, in the context of a structured weight loss program using meal replacements, achieved moderate success compared with the control condition eating plan (101).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [100]
Benefit from a low-fat eating pattern appears to be mostly related to weight loss as opposed to the eating pattern itself.
“Bene fi t from a low-fat eating pattern appears to be mostly related to weight loss as opposed to the eating pattern itself (100,101).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [100]
A larger body of evidence from randomized clinical trials suggests that vegetarian and other plant-based dietary patterns lower weight and improve lipid management, glucose metabolism, blood pressure, and cardiometabolic health.
“A larger body of evidence from randomized clinical trials suggests that vegetarian and other plant-based dietary patterns lower weight29,30,31 and improve lipid management,30,32,33 glucose metabolism,33,34 blood pressure,35,36,37 and cardiometabolic health.38”
From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [34]
In the Look AHEAD trial, the intensive lifestyle intervention resulted in 8.6% weight loss at 1 year, and downstream therapeutic benefits were far-ranging even though benefits were not seen for the primary cardiovascular outcomes.
“The intensive lifestyle intervention resulted in 8.6% weight loss at 1 year, and the downstream therapeutic benefi ts were far-ranging even though bene fi ts were not seen for the primary cardiovascular outcomes (100).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [100]
High-MUFA and vegetarian diets showed greater weight losses, by −1.6 to −2 kg, than control diets.
“High-monounsaturated-fatty-acid (MUFA) [29] and vegetarian diets [35] showed greater weight losses, by −1.6 to −2 kg, than the control diets.”
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
PRISMA-P Group, Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015) · Systematic Reviews · doi:10.1186/2046-4053-4-1 · Cited by 26,223 · see citing works
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa012512 · Cited by 19,011 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
Tuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200105033441801 · Cited by 10,873 · see citing works
GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables
Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., & deBeer, H. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.026 · Cited by 10,681 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799 · see citing works
GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285 · see citing works
Haffner, S. M., Lehto, S., Rönnemaa, T., Pyörälä, K., & Laakso, M. (1998) · New England Journal of Medicine · doi:10.1056/nejm199807233390404 · Cited by 7,000 · see citing works
Luo, D., Wan, X., Liu, J., & Tong, T. (2018) · Statistical Methods in Medical Research · doi:10.1177/0962280216669183 · Cited by 4,066 · see citing works
Global diets link environmental sustainability and human health
Tilman, D. G., & Clark, M. (2014) · Nature · doi:10.1038/nature13959 · Cited by 3,413 · see citing works
How should meta‐regression analyses be undertaken and interpreted?
Thompson, S. G., & Higgins, J. P. T. (2002) · Statistics in Medicine · doi:10.1002/sim.1187 · Cited by 3,026 · see citing works
GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)
Guyatt, G. H., Oxman, A. D., Vist, G., Kunz, R., Brozek, J., Alonso-Coello, P., Montori, V., Akl, E. A., Djulbegovic, B., & Falck-Ytter, Y. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.017 · Cited by 2,798 · see citing works
GRADE guidelines 6. Rating the quality of evidence—imprecision
Guyatt, G. H., Oxman, A. D., Kunz, R., Brozek, J., Alonso-Coello, P., Rind, D., Devereaux, P. J., Montori, V. M., Freyschuss, B., Vist, G., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.01.012 · Cited by 2,693 · see citing works
GRADE guidelines: 7. Rating the quality of evidence—inconsistency
Guyatt, G. H., Oxman, A. D., Kunz, R., Woodcock, J., Brozek, J., Helfand, M., Alonso-Coello, P., Glasziou, P., Jaeschke, R., Akl, E. A., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.03.017 · Cited by 2,320 · see citing works
Meta-analyses involving cross-over trials: methodological issues
Elbourne, D. R., Altman, D. G., Higgins, J. P., Curtin, F., Worthington, H. V., & Vail, A. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.1.140 · Cited by 2,305 · see citing works
Publication and related bias in meta-analysis
Sterne, J. A. C., Gavaghan, D., & Egger, M. (2000) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00242-0 · Cited by 2,282 · see citing works
GRADE guidelines: 2. Framing the question and deciding on important outcomes
Guyatt, G. H., Oxman, A. D., Kunz, R., Atkins, D., Brozek, J., Vist, G., Alderson, P., Glasziou, P., Falck-Ytter, Y., & Schünemann, H. J. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.09.012 · Cited by 1,911 · see citing works
GRADE guidelines: 8. Rating the quality of evidence—indirectness
Guyatt, G. H., Oxman, A. D., Kunz, R., Woodcock, J., Brozek, J., Helfand, M., Alonso-Coello, P., Falck-Ytter, Y., Jaeschke, R., Vist, G., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.04.014 · Cited by 1,843 · see citing works
GRADE guidelines: 5. Rating the quality of evidence—publication bias
Guyatt, G. H., Oxman, A. D., Montori, V., Vist, G., Kunz, R., Brozek, J., Alonso-Coello, P., Djulbegovic, B., Atkins, D., Falck-Ytter, Y., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.01.011 · Cited by 1,819 · see citing works
Ray, K. K., Seshasai, S. R. K., Wijesuriya, S., Sivakumaran, R., Nethercott, S., Preiss, D., Erqou, S., & Sattar, N. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60697-8 · Cited by 1,383 · see citing works
Position of the Academy of Nutrition and Dietetics: Vegetarian Diets
Melina, V., Craig, W., & Levin, S. (2016) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.09.025 · Cited by 1,360 · see citing works
GRADE guidelines: 9. Rating up the quality of evidence
Guyatt, G. H., Oxman, A. D., Sultan, S., Glasziou, P., Akl, E. A., Alonso-Coello, P., Atkins, D., Kunz, R., Brozek, J., Montori, V., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.06.004 · Cited by 1,336 · see citing works
Intensive glucose control and macrovascular outcomes in type 2 diabetes
Turnbull, F. M., Abraira, C., Anderson, R. J., Byington, R. P., Chalmers, J. P., Duckworth, W. C., Evans, G. W., Gerstein, H. C., Holman, R. R., Moritz, T. E., et al. (2009) · Diabetologia · doi:10.1007/s00125-009-1470-0 · Cited by 1,189 · see citing works
Dietary Fiber and Weight Regulation
Howarth, N. C., Saltzman, E. J., & Roberts, S. B. (2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.2001.tb07001.x · Cited by 1,053 · see citing works
Dinu, M., Abbate, R., Gensini, G. F., Casini, A., & Sofi, F. (2017) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2016.1138447 · Cited by 971 · see citing works
GRADE guidelines: 12. Preparing Summary of Findings tables—binary outcomes
Guyatt, G. H., Oxman, A. D., Santesso, N., Helfand, M., Vist, G., Kunz, R., Brozek, J., Norris, S., Meerpohl, J., Djulbegovic, B., et al. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.01.012 · Cited by 836 · see citing works
Schwingshackl, L., Hoffmann, G., Lampousi, A.-M., Knüppel, S., Iqbal, K., Schwedhelm, C., Bechthold, A., Schlesinger, S., & Boeing, H. (2017) · European Journal of Epidemiology · doi:10.1007/s10654-017-0246-y · Cited by 799 · see citing works
GRADE guidelines: 13. Preparing Summary of Findings tables and evidence profiles—continuous outcomes
Guyatt, G. H., Thorlund, K., Oxman, A. D., Walter, S. D., Patrick, D., Furukawa, T. A., Johnston, B. C., Karanicolas, P., Akl, E. A., Vist, G., et al. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.08.001 · Cited by 772 · see citing works
Guyatt, G., Oxman, A. D., Sultan, S., Brozek, J., Glasziou, P., Alonso-Coello, P., Atkins, D., Kunz, R., Montori, V., Jaeschke, R., et al. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.01.006 · Cited by 762 · see citing works
Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-analysis
Johnston, B. C., Kanters, S., Bandayrel, K., Wu, P., Naji, F., Siemieniuk, R. A., Ball, G. D. C., Busse, J. W., Thorlund, K., Guyatt, G., et al. (2014) · JAMA · doi:10.1001/jama.2014.10397 · Cited by 704 · see citing works
Bechthold, A., Boeing, H., Schwedhelm, C., Hoffmann, G., Knüppel, S., Iqbal, K., De Henauw, S., Michels, N., Devleesschauwer, B., Schlesinger, S., et al. (2019) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2017.1392288 · Cited by 693 · see citing works
Vegetarian dietary patterns and mortality in Adventist Health Study 2
Orlich, M. J., Singh, P. N., Sabaté, J., Jaceldo-Siegl, K., Fan, J., Knutsen, S., Beeson, W. L., & Fraser, G. E. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.6473 · Cited by 607 · see citing works
Schwingshackl, L., Schwedhelm, C., Hoffmann, G., Lampousi, A.-M., Knüppel, S., Iqbal, K., Bechthold, A., Schlesinger, S., & Boeing, H. (2017) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.117.153148 · Cited by 600 · see citing works
Vegetarian Diets and Blood Pressure: A Meta-analysis
Yokoyama, Y., Nishimura, K., Barnard, N. D., Takegami, M., Watanabe, M., Sekikawa, A., Okamura, T., & Miyamoto, Y. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.14547 · Cited by 530 · see citing works
Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus
Mann, J. I., Leeuw, I. D., Hermansen, K., Karamanos, B. G., Karlström, B., Katsilambros, N. L., Riccardi, G., Rivellese, A. A., Rizkalla, S. W., Slama, G., et al. (2004) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/s0939-4753(04)80028-0 · Cited by 520 · see citing works
The Primary Prevention of Myocardial Infarction
Manson, J. E., Tosteson, H., Ridker, P. M., Satterfield, S., Hebert, P., O'Connor, G. T., Buring, J. E., & Hennekens, C. H. (1992) · New England Journal of Medicine · doi:10.1056/nejm199205213262107 · Cited by 506 · see citing works
Barnard, N. D., Cohen, J., Jenkins, D. J., Turner-McGrievy, G., Gloede, L., Green, A., & Ferdowsian, H. (2009) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.26736h · Cited by 449 · see citing works
Self-citationVegetarian diets and incidence of diabetes in the Adventist Health Study-2
Tonstad, S., Stewart, K., Oda, K., Batech, M., Herring, R. P., & Fraser, G. E. (2013) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2011.07.004 · Cited by 442 · see citing works
Wang, X., Lin, X., Ouyang, Y. Y., Liu, J., Zhao, G., Pan, A., & Hu, F. B. (2016) · Public Health Nutrition · doi:10.1017/s1368980015002062 · Cited by 412 · see citing works
Pleiotropic Effects of Statins: Benefit Beyond Cholesterol Reduction?
Robinson, J. G., Smith, B., Maheshwari, N., & Schrott, H. G. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.05.085 · Cited by 407 · see citing works
Huang, T., Yang, B., Zheng, J., Li, G., Wahlqvist, M. L., & Li, D. (2012) · Annals of Nutrition and Metabolism · doi:10.1159/000337301 · Cited by 382 · see citing works
Schwingshackl, L., Schwedhelm, C., HOFFMANN, G. E., Knüppel, S., Iqbal, K., Andriolo, V., Bechthold, A., Schlesinger, S., & Boeing, H. (2017) · Advances in Nutrition · doi:10.3945/an.117.017178 · Cited by 350 · see citing works
Wang, F., Zheng, J., Yang, B., Jiang, J., Fu, Y., & Li, D. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.115.002408 · Cited by 340 · see citing works
Kendall, A., Levitsky, D., Strupp, B., & Lissner, L. (1991) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/53.5.1124 · Cited by 338 · see citing works
Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials.
Huang, R.-Y., Huang, C.-C., Hu, F. B., & Chavarro, J. E. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3390-7 · Cited by 321 · see citing works
Kahleova, H., Matoulek, M., Malinska, H., Oliyarnik, O., Kazdova, L., Neskudla, T., Skoch, A., Hajek, M., Hill, M., Kahle, M., et al. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.03209.x · Cited by 312 · see citing works
Diet and the environment: does what you eat matter?
Marlow, H. J., Hayes, W. K., Soret, S., Carter, R. L., Schwab, E. R., & Sabaté, J. (2009) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.26736z · Cited by 301 · see citing works
GRADE guidelines: 10. Considering resource use and rating the quality of economic evidence
Brunetti, M., Shemilt, I., Pregno, S., Vale, L. D., Oxman, A. D., Lord, J. L., Sisk, J. E., Ruiz, F. J., Hill, S. R., Guyatt, G. H., et al. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.04.012 · Cited by 281 · see citing works
Barnard, N. D., Levin, S. M., & Yokoyama, Y. (2015) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2014.11.016 · Cited by 266 · see citing works
Crowe, F. L., Appleby, P. N., Travis, R. C., & Key, T. J. (2013) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.112.044073 · Cited by 263 · see citing works
Does a vegetarian diet reduce the occurrence of diabetes?
Snowdon, D. A., & Phillips, R. L. (1985) · American Journal of Public Health · doi:10.2105/ajph.75.5.507 · Cited by 248 · see citing works
Appleby, P. N., Davey, G. K., & Key, T. J. (2002) · Public Health Nutrition · doi:10.1079/phn2002332 · Cited by 244 · see citing works
Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis.
(2014) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2223-3652.2014.10.04 · Cited by 243 · see citing works
Mishra, S., Xu, J. Y., Agarwal, U., Gonzales, J., Levin, S., & Barnard, N. D. (2013) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.92 · Cited by 240 · see citing works
Pan, A., Sun, Q., Bernstein, A. M., Manson, J. E., Willett, W. C., & Hu, F. B. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.6633 · Cited by 230 · see citing works
Pettersen, B. J., Anousheh, R., Fan, J., Jaceldo‐Siegl, K., & Fraser, G. E. (2012) · Public Health Nutrition · doi:10.1017/s1368980011003454 · Cited by 214 · see citing works
Kwok, C. S., Umar, S., Myint, P. K., Mamas, M. A., & Loke, Y. K. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.07.080 · Cited by 205 · see citing works
Sievenpiper, J. L., Chan, C. B., Dworatzek, P. D., Freeze, C., & Williams, S. L. (2018) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2017.10.009 · Cited by 200 · see citing works
Self-citationMannucci, E., Monami, M., Lamanna, C., Gori, F., & Marchionni, N. (2009) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2009.03.021 · Cited by 198 · see citing works
Discordance between reported intention-to-treat and per protocol analyses
Porta, N., Bonet, C., & Cobo, E. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.09.013 · Cited by 187 · see citing works
Tian, S., Xu, Q., Jiang, R., Han, T., Sun, C., & Na, L. (2017) · Nutrients · doi:10.3390/nu9090982 · Cited by 174 · see citing works
Nicholson, A. S., Sklar, M., Barnard, N. D., Gore, S., Sullivan, R., & Browning, S. (1999) · Preventive Medicine · doi:10.1006/pmed.1999.0529 · Cited by 171 · see citing works
Vegetarian and vegan diets in type 2 diabetes management
Barnard, N. D., Katcher, H. I., Jenkins, D. J., Cohen, J., & Turner-McGrievy, G. (2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.2009.00198.x · Cited by 164 · see citing works
Self-citationLee, Y., Kim, S.-A., Lee, I., Kim, J., Park, K., Jeong, J.-Y., Jeon, J., Shin, J.-Y., & Lee, D. (2016) · PLoS ONE · doi:10.1371/journal.pone.0155918 · Cited by 145 · see citing works
Chiu, Y., Hsu, C., Chiu, T. H. T., Lee, C., Liu, T., Tsao, C. K., Chuang, S.-C., & Hsiung, C. A. (2015) · British Journal Of Nutrition · doi:10.1017/s0007114515002937 · Cited by 138 · see citing works
Viguiliouk, E., Stewart, S., Jayalath, V., Ng, A., Mirrahimi, A., De Souza, R., Hanley, A., Bazinet, R., Blanco Mejia, S., Leiter, L., et al. (2015) · Nutrients · doi:10.3390/nu7125509 · Cited by 130 · see citing works
Self-citationKim, K., Hyeon, J., Lee, S. A., Kwon, S. O., Lee, H.-J., Keum, N., Lee, J., & Park, S. M. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.005983 · Cited by 120 · see citing works
Vegetarian diet, change in dietary patterns, and diabetes risk: A prospective study
Chiu, T. H. T., Pan, W.-H., Lin, M.-N., & Lin, C.-L. (2018) · Nutrition & Diabetes · doi:10.1038/s41387-018-0022-4 · Cited by 116 · see citing works
Yang, C., Pan, L., Sun, C., Xi, Y., Wang, L., & Li, D. (2016) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2016.01.040 · Cited by 110 · see citing works
de Mello, V. D., Zelmanovitz, T., Perassolo, M. S., de Azevedo, M. J., & Gross, J. L. (2006) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.5.1032 · Cited by 109 · see citing works
Kontessis, P. S., Bossinakou, I., Sarika, L., et al. (1995) · Diabetes Care · doi:10.2337/diacare.18.9.1233 · Cited by 97 · see citing works
Vegetarian Diets in the Prevention and Treatment of Type 2 Diabetes
Kahleová, H., & Pelikánová, T. (2015) · Journal of the American College of Nutrition · doi:10.1080/07315724.2014.976890 · Cited by 71 · see citing works
Self-citationAnimal Versus Plant Protein Meals in Individuals With Type 2 Diabetes and Microalbuminuria
Wheeler, M. L., Fineberg, S. E., Fineberg, N. S., Gibson, R. G., & Hackward, L. L. (2002) · Diabetes Care · doi:10.2337/diacare.25.8.1277 · Cited by 71 · see citing works
Usefulness of Vegetarian and Vegan Diets for Treating Type 2 Diabetes
Trapp, C., & Barnard, N. D. (2010) · Current Diabetes Reports · doi:10.1007/s11892-010-0093-7 · Cited by 68 · see citing works
Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation
Chuang, S., Chiu, T. H. T., Lee, C.-Y., Liu, T., Tsao, C. K., Hsiung, C. A., & Chiu, Y. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000001068 · Cited by 67 · see citing works
Barnard, N. D., Levin, S., Gloede, L., & Flores, R. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.11.017 · Cited by 63 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report
Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K. H. K., MacLeod, J., Mitri, J., Pereira, R. F., Rawlings, K., Robinson, S., et al. (2019) · Diabetes Care · doi:10.2337/dci19-0014 · Cited by 1,496 · see citing works
Evidence-based European recommendations for the dietary management of diabetes
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), Aas, A.-M., Axelsen, M., Churuangsuk, C., Hermansen, K., Kendall, C. W. C., Kahleova, H., Khan, T., Lean, M. E. J., Mann, J. I., et al. (2023) · Diabetologia · doi:10.1007/s00125-023-05894-8 · Cited by 262 · see citing works
Self-citationChuruangsuk, C., Hall, J., Reynolds, A., Griffin, S. J., Combet, E., & Lean, M. E. J. (2022) · Diabetologia · doi:10.1007/s00125-021-05577-2 · Cited by 204 · see citing works
Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance
Kim, J. Y. (2021) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes20065 · Cited by 193 · see citing works
Papamichou, D., Panagiotakos, D. B., & Itsiopoulos, C. (2019) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2019.02.004 · Cited by 182 · see citing works
Dinu, M., Pagliai, G., Angelino, D., Rosi, A., Dall'Asta, M., Bresciani, L., Ferraris, C., Guglielmetti, M., Godos, J., Del Bo', C., et al. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa006 · Cited by 164 · see citing works
Sievenpiper, J. L. (2020) · Nutrition Reviews · doi:10.1093/nutrit/nuz082 · Cited by 144 · see citing works
Self-citationKorsmo‐Haugen, H., Brurberg, K. G., Mann, J., & Aas, A. (2019) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.13499 · Cited by 115 · see citing works
Kahleova, H., Salas-Salvadó, J., Rahelić, D., Kendall, C. W., Rembert, E., & Sievenpiper, J. L. (2019) · Nutrients · doi:10.3390/nu11092209 · Cited by 114 · see citing works
Self-citationCardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial
Landry, M. J., Ward, C. P., Cunanan, K. M., Durand, L. R., Perelman, D., Robinson, J. L., Hennings, T., Koh, L., Dant, C., Zeitlin, A., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.44457 · Cited by 109 · see citing works
Selinger, E., Neuenschwander, M., Koller, A., Gojda, J., Kühn, T., Schwingshackl, L., Barbaresko, J., & Schlesinger, S. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2075311 · Cited by 114 · see citing works
“…identified meta-analyses on RCTs for the effect of a vegan diet on anthropometric and cardiometabolic markers, including weight (Rees et al., 2021; Viguiliouk et al. 2019), BMI (Rees et al., 2021; Viguiliouk et al. 2019), waist circumference (Picasso et al. 2019), systolic and diastolic blood…”
BackgroundInfluentialAn update on the Mediterranean, vegetarian, and DASH eating patterns in people with type 2 diabetes
Benson, G., & Hayes, J. (2020) · Diabetes Spectrum · doi:10.2337/ds19-0073 · Cited by 30 · see citing works
Plant Foods, Healthy Plant-Based Diets, and Type 2 Diabetes: A Review of the Evidence
del Carmen Fernández-Fígares Jiménez, M. (2024) · Nutrition Reviews · doi:10.1093/nutrit/nuad099 · Cited by 20 · see citing works
Dietary Interventions for Hypertriglyceridemia
Kirkpatrick, C. F., Petersen, K. S., Kris-Etherton, P. M., & Maki, K. C. (2026) · Current Atherosclerosis Reports · doi:10.1007/s11883-026-01444-w
- Authors
- Viguiliouk, E., Kendall, C. W., Kahleová, H., Rahelić, D., Salas-Salvadó, J., Choo, V. L., Mejia, S. B., Stewart, S. E., Leiter, L. A., Jenkins, D. J., & Sievenpiper, J. L.
- Affiliations
- St. Michael's Hospital (CA)
- Physicians Committee for Responsible Medicine (US)
- University Hospital Dubrava (HR)
- Corresponding author
- Sievenpiper, John L.
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 38
- Issue
- 3
- Pages
- 1133-1145
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2807837295
- Cited by
- 201
- References
- 78
- Citations by year
- 2026: 17 · 2025: 21 · 2024: 30 · 2023: 29 · 2022: 27 · 2021: 32 · 2020: 26 · 2019: 18 · 2018: 1
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (129920)
- Institute of Nutrition, Metabolism and Diabetes
- Canadian Society of Endocrinology and Metabolism
- Banting and Best Diabetes Centre, University of Toronto
- Peanut Institute
- Government of Canada
- Flax Council of Canada
- National Dried Fruit Trade Association
- Griffin Hospital
- St. Michael's Hospital Foundation
- Canola Council of Canada
- Ministerio de Ciencia y Tecnología
- Abbott Laboratories
- Departament de Salut, Generalitat de Catalunya
- Eli Lilly and Company
- Bayer
- Ontario Ministry of Research, Innovation and Science
- Instituto de Salud Carlos III
- Hospital for Sick Children
- European Commission
- Canada Research Chairs
- Danone Institute of Canada
- Canada Foundation for Innovation
- Physicians' Services Incorporated Foundation
- California Strawberry Commission
- Meso Scale Diagnostics
- Unilever
- Canadian Diabetes Association
- Arizona State University
- Johnson and Johnson
- Novartis
- Coca-Cola
- Canadian Agri-Food Policy Institute
- PepsiCo
- General Mills
- Kellogg's
- Instituto Danone
- Novo Nordisk Canada
- Alpro Foundation
- International Nut and Dried Fruit Council
- Ontario Research Foundation
- Saskatchewan Pulse Growers
- Pfizer Canada
- Canadian Nutrition Society
- Institute of Food Technologists
- Almond Board of California
- AstraZeneca Canada
- Merck Sharp and Dohme
- Amgen Canada
- Cognitive Neuroscience Society
- Advanced Foods and Materials Network
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- vegetarian diet, diabetes mellitus, glycemic control, HbA1c, fasting blood glucose, LDL cholesterol, non-HDL cholesterol, body weight, adiposity, waist circumference, blood pressure, fasting insulin, triglycerides, cardiometabolic risk factors, nutritional therapy, dietary intervention, randomized controlled trials, GRADE certainty of evidence, plant-based diet
- MeSH terms
- Adolescent, Adult, Blood Pressure, Body Weight, Diabetes Mellitus, Female, Humans, Lipids, Male, Middle Aged, Obesity, Diet, Vegetarian, Randomized Controlled Trials as Topic, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
