Dietary Patterns and Cardiometabolic Outcomes in Diabetes: A Summary of Systematic Reviews and Meta-Analyses
Open accessAbstract
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.
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In patients with type 2 diabetes, following the Mediterranean diet led to significant reductions in cardiovascular disease incidence.
“In patients with type 2 diabetes, following MD led to significant reductions in CVD incidence (RR 0.62; 95% CI 0.5 to 0.78) [83].”
From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [83]
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- Authors
- Kahleova, H., Salas-Salvadó, J., Rahelić, D., Kendall, C. W., Rembert, E., & Sievenpiper, J. L.
- Affiliations
- Physicians Committee for Responsible Medicine, Washington, DC 20016, USA
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER Obn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- University of Zagreb (HR)
- St. Michael's Hospital (CA)
- Physicians Committee for Responsible Medicine (US)
- Corresponding author
- Sievenpiper, John L
- ORCID
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2019-09-13
- Volume
- 11
- Issue
- 9
- Pages
- 2209
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC6770579
- OpenAlex
- W2972375267
- Cited by
- 114
- References
- 72
- Citations by year
- 2026: 11 · 2025: 7 · 2024: 22 · 2023: 25 · 2022: 19 · 2021: 19 · 2020: 10 · 2019: 1
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Rovira & Virgili repository (submittedVersion, cc-by)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Almond Board of California
- Dairy Farmers of Canada
- Canadian Cardiovascular Society
- Diabetes Canada
- European Food Safety Authority
- Glycemic Index Foundation
- Alberta Pulse Growers Commission
- Loblaw Companies Limited
- Physicians Committee for Responsible Medicine
- Physicians' Services Incorporated Foundation
- Society for Endocrinology
- University of Toronto
- European Association for the Study of Diabetes
- International Nut and Dried Fruit Council
- International Sweeteners Association
- Canadian Institutes of Health Research
- Banting and Best Diabetes Centre, University of Toronto
- Obesity Canada
- Ontario Ministry of Research and Innovation
- 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
- dietary habits, diabetes mellitus, cardiometabolic outcomes, Mediterranean diet, DASH diet, Portfolio diet, Nordic diet, vegetarian diet, cardiovascular disease incidence, cardiovascular mortality, coronary artery disease, stroke, cardiometabolic risk factors, nutritional therapy, GRADE quality of evidence, risk of bias assessment, heterogeneity, publication bias, reporting bias
- MeSH terms
- Dietary Approaches To Stop Hypertension, Systematic Reviews as Topic, Cardiovascular Diseases, Diabetes Mellitus, Diet, Humans, Metabolic Diseases, Risk Factors, Scandinavian and Nordic Countries, Diet, Vegetarian, Meta-Analysis as Topic, MEDLINE, Diet, Mediterranean, Nutrition Therapy, Diabetes Complications
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 ›
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