Nutritional advice

Objectives:
Previous meta-analysis studies have indicated inverse associations between some carotenoids and risks of metabolic syndrome, cardiovascular disease, cancer and all-cause mortality. However, the results for associations between carotenoids and type 2 diabetes (T2D) remain inconsistent and no systematic assessment has been done on this topic. Therefore, this review article (meta-analysis) has been conducted.

Do higher dietary intakes and circulating concentrations of carotenoids reduce risk of type 2 diabetes?

Study design:
This review article included 13 studies.

Results and conclusions:
The investigators found for the the highest versus the lowest categories of dietary intake of β-carotene a significantly reduced risk of 22% for type 2 diabetes [pooled RR = 0.78, 95% CI = 0.70 to 0.87, I2 = 13.7%, n = 6].
This significantly reduced risk was also found for total carotenoids (n = 2), α-carotene (n = 4), and lutein/zeaxanthin (n = 4), with pooled RRs ranging from 0.80 to 0.91, whereas no significant associations were observed for β-cryptoxanthin and lycopene.

The investigators found for the the highest versus the lowest categories of circulating concentration of β-carotene a significantly reduced risk of 40% for type 2 diabetes [pooled RR = 0.60, 95% CI = 0.46 to 0.78, I2 = 56.2%, n = 7].
This significantly reduced risk was also found for total carotenoids (n = 3), lycopene (n = 4), and lutein (n = 2), with pooled RRs ranging from 0.63 to 0.85, whereas no significant association was found for circulating concentrations of α-carotene and zeaxanthin when comparing extreme categories.

The investigators found dose-response analysis indicated that nonlinear relations were observed for circulating concentrations of α-carotene, β-carotene, lutein and total carotenoids [all p-nonlinearity 0.05], but not for other carotenoids or dietary exposures.

The investigators concluded that higher dietary intakes and circulating concentrations of total carotenoids, especially β-carotene, are associated with a lower risk of type 2 diabetes. More studies are needed to confirm the causality and explore the role of foods rich in carotenoids in prevention of type 2 diabetes.

Original title:
Dietary Intake and Circulating Concentrations of Carotenoids and Risk of Type 2 Diabetes: A Dose-Response Meta-Analysis of Prospective Observational Studies by Jiang YW, Sun ZH, [...], Pan A.

Link:
https://pubmed.ncbi.nlm.nih.gov/33979433/

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Objectives:
Although current guidelines recommend reduction of salt intake in patients with diabetes, the benefits of reducing salt intake in people with type 2 diabetes mellitus (T2DM) lack clear evidence. Therefore, this review articles has been conducted.

Does dietary sodium restriction causally reduce blood pressure in patients with type 2 diabetes mellitus (T2DM)?

Study design:
This review article included 8 RCTs with 10 trials (7 cross-over and 3 parallel designs).
No publication bias was found from Begg's and Egger's tests.

Results and conclusions:
The investigators found compared with ordinary sodium intake, dietary sodium restriction significantly decreased 24-hour urine sodium level [WMD = -38.430 mmol/24h, 95% CI = -41.665 mmol/24h to -35.194 mmol/24h].

The investigators found dietary sodium restriction significantly lowered systolic blood pressure [WMD = -5.574 mm Hg, 95% CI = -8.314 to -2.834 mm Hg, I2 = 0.0%] and diastolic blood pressure [WMD = -1.675 mm Hg, 95% CI = -3.199 to -0.150 mm Hg, I2 = 0.0%].

The investigators concluded that dietary sodium restriction causally reduces systolic blood pressure and diastolic blood pressure in patients with type 2 diabetes mellitus (T2DM).

Original title:
Effect of dietary sodium restriction on blood pressure in type 2 diabetes: A meta-analysis of randomized controlled trials by Ren Y, Liqiang Qin L, […], Ma Y.

Link:
https://pubmed.ncbi.nlm.nih.gov/33838996/

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Salt consists of sodium and chloride. So a dietary sodium restriction means a reduction in dietary salt intake.

A diet with dietary salt restriction is a diet with maximum 0.2 grams of salt per 100 kcal.

The easiest way to follow this diet is to choose only products/meals with maximum 0.2 grams of salt per 100 kcal. These products from the supermarket contain maximum 0.2 grams of salt per 100 kcal.

However, the most practical way to follow this diet is, all your daily consumed products/meals should contain on average maximum 0.2 grams of salt per 100 kcal.
To do this, use the 7-points nutritional profile app to see if your daily diet contains maximum 0.2 grams of salt per 100 kcal.

Objectives:
Evidence regarding associations between potato consumption and type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) risks is accumulating. Therefore, this review article has been conducted.

Does a high potato intake increase type 2 diabetes and gestational diabetes mellitus (diabetes mellitus during pregnancy) risk?

Study design:
This review article included 19 studies (13 for type 2 diabetes and 6 for gestational diabetes mellitus) with a total of 21,357 type 2 diabetes cases among 323,475 participants and 1,516 gestational diabetes mellitus cases among 29,288 pregnancies.

Results and conclusions:
The investigators found meta-analysis showed a significantly increased risk of 19% [RR = 1.19, 95% CI = 1.06 to 1.34] for type 2 diabetes for total potato intakes among Western populations.

The investigators found meta-analysis showed a significantly increased risk of 8% [RR = 1.08, 95% CI = 1.00 to 1.16] for type 2 diabetes for baked/boiled/mashed potato intakes among Western populations.

The investigators found meta-analysis showed a significantly increased risk of 33% [RR = 1.33, 95% CI = 1.03 to 1.70] for type 2 diabetes for French fries/fried potato intakes among Western populations.

The investigators found dose-response meta-analysis demonstrated a significantly increased type 2 diabetes risk by 10% [95% CI = 1.07 to 1.14, p for trend 0.001], 2% [95% CI = 1.00 to 1.04, p for trend = 0.02] and 34% [95% CI = 1.24 to 1.46, p for trend 0.001] among Western populations for each 80 g/day (serving) increment in total potato, unfried potato and fried potato intakes, respectively.

The investigators found dose-response meta-analysis demonstrated a significantly increased gestational diabetes mellitus risk by 22% [95% CI = 1.06 to 1.42, p for trend 0.007] among Western populations for each 80 g/day (serving) increment in total potato intakes.

The investigators found dose-response meta-analysis demonstrated a significantly increased gestational diabetes mellitus risk by 26% [95% CI = 1.07 to 1.48, p for trend = 0.006] among Western populations for each 80 g/day (serving) increment in unfried potato intakes.

The investigators concluded that higher potato intake (at least 80g per day) is associated with higher type 2 diabetes risk among Western populations. The positive relationship presents a significant dose-response manner. Wisely controlled potato consumption may confer potential glucometabolic benefits.

Original title:
Dietary potato intake and risks of type 2 diabetes and gestational diabetes mellitus by Guo F, Zhang Q, [...], Ma L.

Link:
https://pubmed.ncbi.nlm.nih.gov/34130021/

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Objectives:
Does vitamin C supplementation improve triglyceride and cholesterol levels in patients with type 2 diabetes mellitus?

Study design:
This review article included 15 studies with 872 participants.

Results and conclusions:
The investigators found, findings from 15 studies indicated that vitamin C supplementation significantly decreased triglyceride (TG) levels [WMD= -16.48 mg/dL, 95% CI = -31.89 to -1.08, p 0.001] and total cholesterol (TC) levels [WMD = -13.00 mg/dL, 95% CI = -23.10 to -2.91, p 0.001] in patients with type 2 diabetes mellitus.

The investigators found, however, vitamin C supplementation failed to improve LDL (bad cholesterol) and HDL cholesterol (good cholesterol) levels. 

The investigators found the meta-regression analysis suggested that lipid profile improvement was affected by duration of vitamin C treatment.

The investigators found dose-response analysis showed that vitamin C supplementation changed LDL cholesterol significantly based on vitamin C dose.

The investigators concluded that vitamin C supplementation improves lipid profile via decreases in triglyceride and total cholesterol levels in patients with type 2 diabetes mellitus. It appears that vitamin C supplementation is more beneficial to lipid profile in long-term vs. short term interventions.

Original title:
Does vitamin C supplementation exert profitable effects on serum lipid profile in patients with type 2 diabetes? A systematic review and dose-response meta-analysis by Namkhah Z, Ashtary-Larky D, […], Asbaghi O.

Link:
https://pubmed.ncbi.nlm.nih.gov/33984490/

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Objectives:
Does spirulina supplementation improve glycemic related markers (like, fasting blood glucose, post prandial blood sugar and HbA1c levels) and lipid profile (like, triglyceride and cholesterol levels) among type 2 diabetes patients?

Study design:
This review article included 8 RCTs (9 arms).

Results and conclusions:
The investigators found, spirulina supplementation significantly reduced fasting blood glucose levels [-17.88 mg/dL, 95% CI = -26.99 to -8.78, I2 = 25%] among type 2 diabetes patients.

The investigators found, spirulina supplementation significantly reduced triglyceride levels [-30.99 mg/dL, 95% CI = -45.20 to -16.77, I2 = 50%] among type 2 diabetes patients.

The investigators found, spirulina supplementation significantly reduced total cholesterol levels [-18.47 mg/dL, 95% CI = -33.54 to -3.39, I2 = 73%] among type 2 diabetes patients.

The investigators found, spirulina supplementation significantly reduced LDL cholesterol (bad cholesterol) levels [-20.04 mg/dL, 95% CI = -34.06 to -6.02, I2 = 75%] among type 2 diabetes patients.

The investigators found, spirulina supplementation significantly reduced VLDL cholesterol levels [-6.96 mg/dL, 95% CI = -9.71 to -4.22, I2 = 33%] among type 2 diabetes patients.

The investigators found, spirulina supplementation significantly increased HDL cholesterol (good cholesterol) levels among type 2 diabetes patients.

The investigators found no significant effect on HbA1C or post prandial blood sugar among type 2 diabetes patients following spirulina supplementation.

The investigators concluded that spirulina supplementation has beneficial effects on fasting blood glucose and blood lipid profiles among type 2 diabetes patients.

Original title:
The effect of spirulina on type 2 diabetes: a systematic review and meta-analysis by Hatami E, Ghalishourani SS, […], Mansour-Ghanaei F.

Link:
https://pubmed.ncbi.nlm.nih.gov/34178867/

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Objectives:
Does grapes/grape products supplementation improve glycemic indices (like HOMA-IR, Hb1Ac and fasting insulin level) in adults or in other words, does eating grapes or grape products causally improve glycemic indices in adults?

Study design:
This review article included 29 RCTs with a total of 1,297 participants.

Results and conclusions:
The investigators found, overall, the grapes/grape products supplementation significantly reduced homeostatic model assessment of insulin resistance (HOMA-IR) [WMD = -0.54, 95% CI = -0.91 to -0.17, p = 0.004] in adults.   
Significantly because the calculated p-value of = 0.004 was less than the p-value of 0.05.

The investigators found, however, the grapes/grape products supplementation did not affect fasting insulin levels [WMD = -0.90 μIU/mL, 95% CI = -1.04 to 2.84, p = 0.362] and hemoglobin A1c (Hb1Ac) percentage [WMD = 0.00%, 95% CI = -0.10 to 0.11, p = 0.916] in the main analyses.
Did not affect because the calculated p-value of 0.916 was larger than the p-value of 0.05.

The investigators concluded that the grapes/grape products supplementation reduces homeostatic model assessment of insulin resistance (HOMA-IR) in adults. Further, large-scale RCTs with longer duration are required to confirm these results.

Original title:
The effect of grapes/grape products on glycemic response: A systematic review and meta-analysis of randomized controlled trials by Moodi V, Abedi S, […], Miraghajani M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33893683/

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Homeostatic model assessment of insulin resistance (HOMA-IR) is a method for assessing β-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin or C-peptide concentrations. HOMA-IR is an indicator of insulin resistance in diabetic patients. The higher the value, the more resistant you are to insulin. Diabetic patients often have a high HOMA-IR value.

Objectives:
Does chromium supplementation improve lipid profile (serum levels of triglyceride and cholesterol) in patients with type 2 diabetes mellitus (T2DM)?

Study design:
This review article included  24 RCTs (with 28 effect sizes).

Results and conclusions:
The investigators found that chromium supplementation resulted in a significant decrease in serum levels of triglyceride (TG) in patients with type 2 diabetes mellitus [MD = -6.54 mg/dL, 95 % CI = -13.08 to -0.00, p = 0.050].
Significant means that there is an association with a 95% confidence.

The investigators found that chromium supplementation resulted in a significant decrease in serum levels of total cholesterol (TC) in patients with type 2 diabetes mellitus [WMD = -7.77 mg/dL, 95 % CI = -11.35 to -4.18, p 0.001].

The investigators found that chromium supplementation significantly increased high-density lipoprotein cholesterol (HDL cholesterol or good cholesterol) in patients with type 2 diabetes mellitus [WMD = 2.23 mg/dL, 95 % CI = 0.07 to 4.40, p = 0.043] level.

The investigators found, however, chromium supplementation did not have significant effects on low-density lipoprotein cholesterol (LDL cholesterol or bad cholesterol) in patients with type 2 diabetes mellitus [WMD = -8.54 mg/dL, 95 % CI = -19.58 to 2.49, p = 0.129] level.

The investigators concluded that chromium supplementation decreases serum levels of triglyceride (TG) and total cholesterol (TC) and increases HDL cholesterol (good cholesterol) levels in patients with type 2 diabetes mellitus. It should be noted that the lipid-lowering properties of chromium supplementation are small and may not reach clinical importance.

Original title:
Effects of chromium supplementation on lipid profile in patients with type 2 diabetes: A systematic review and dose-response meta-analysis of randomized controlled trials by Asbaghi O, Naeini F, […], Naeini AA.

Link:
https://pubmed.ncbi.nlm.nih.gov/33813266/

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Objectives:
Does L-arginine supplementation improve biomarkers (fasting blood sugar, insulin, HbA1c and HOMA-IR values) of glycemic control in adults?

Study design:
This review article included 12 randomised clinical trials (RCTs).

Results and conclusions:
The investigators found L-arginine supplementation had no significant effect on serum fasting blood sugar (FBS) [weighted mean difference (WMD) = -3.38 mg/dL, 95% CI = -6.79 to 0.04, p = 0.53], serum insulin [WMD = -0.12 Hedges' g, 95% CI = -0.33 to 0.09, p = 0.27], glycated haemoglobin A1c (HbA1c) [WMD = -0.04%, 95% CI = -0.25 to 0.17, p = 0.71] and homeostasis model assessment for insulin resistance (HOMA-IR) [WMD = -0.48, 95% CI = -1.15 to 0.19, p = 0.15].
No significant because the calculated p-value of 0.15 was larger than the p-value of 0.05.

The investigators concluded although several animal studies have proposed that L-arginine supplementation might improve blood glucose control, the present review article could not confirm this benefit in humans.

Original title:
Effects of L-arginine supplementation on biomarkers of glycemic control: a systematic review and meta-analysis of randomised clinical trials by Karimi E, Hatami E, […], Askari G.

Link:
https://pubmed.ncbi.nlm.nih.gov/33426939/

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Arginine is classified as a semiessential or conditionally essential amino acid, depending on the developmental stage and health status of the individual, that helps the body build protein. L-arginine is also found in most protein-rich foods, including fish, red meat, poultry, soy, whole grains, beans and dairy products.
 

Objectives:
Does garlic supplementation reduce adiponectin and leptin serum levels?

Study design:
This review article included 5 RCTs.

Results and conclusions:
The investigators found that garlic supplementation did not significantly affect adiponectin [Hedges's = 0.20, 95% CI = -0.06 to 0.47, p = 0.12] and leptin [Hedges's = 0.08, 95% CI = -0.26 to 0.41, p = 0.65] concentrations in comparison with placebo.

The investigators found, however, in the subgroup analysis, significantly increased serum adiponectin level was seen following garlic supplementation in trials with a mean age of participants ˂30 years [Hedges's = 0.44, 95% CI = 0.01 to 0.87, p = 0.04], the doses ˂1.5 g/day [Hedges's = 0.38, 95% CI = 0.02 to 0.71, p = 0.04] and trials with duration ≥8 weeks [Hedges's = 0.48, 95% CI = 0.08 to 0.89, p = 0.02].

The investigators concluded that ˂1.5 g/day garlic supplementation during ≥8 weeks reduces adiponectin level among participants ˂30 years.

Original title:
Systematic review and meta-analysis of randomized, controlled trials on the effects of garlic supplementation on serum adiponectin and leptin levels by Shekarchizadeh-Esfahani P, Hassani B, […], Soraya N.

Link:
https://pubmed.ncbi.nlm.nih.gov/33792129/

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Adiponectin is a fat-derived hormone that appears to play a crucial role in protecting against insulin resistance/diabetes and atherosclerosis (atherosclerosis is the dominant cause of cardiovascular disease (CVD)). Decreased adiponectin levels are thought to play a central role in the development of obesity, cardiovascular disease and type 2 diabetes in humans.

Objectives:
Previous meta-analyses, with some methodological controversies, have assessed the relation between nut consumption and type 2 diabetes (T2D) risk and pointed to contradictory results. Therefore, this review article has been conducted.

Does nut consumption reduce risk of type 2 diabetes?

Study design:
This review article included 5 prospective cohort studies and 3 cross-sectional studies.
The certainty of the evidence using NutriGrade was very low for all the exposures.

Results and conclusions:
The investigators found meta-analyses of cross-sectional studies and prospective cohort studies, comparing the highest with the lowest categories, revealed a nonsignificant association between total nut consumption and type 2 diabetes.
Nonsignificant means that there is no association with a 95% confidence.

The investigators found meta-analyses of prospective cohort studies showed that peanut butter consumption significantly reduced type 2 diabetes incidence with 13% [RR = 0.87, 95% CI = 0.77 to 0.98, I2 = 50.6%, p = 0.16], whereas no association was observed between peanuts or tree nuts and type 2 diabetes.

The investigators found there was no evidence of a linear dose-response or nonlinear dose-response gradient for total nut and peanut consumption in prospective cohort studies.

The investigators concluded peanut butter consumption may reduce type 2 diabetes incidence. May reduce because the certainty of the evidence using NutriGrade was very low.

Original title:
Nut consumption and type 2 diabetes risk: a systematic review and meta-analysis of observational studies by Becerra-Tomás N, Paz-Graniel I, […], Salas-Salvadó J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33471083/

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Objectives:
Peripheral neuropathy (PN) is common in patients with diseases that are in turn associated with deficiency of the B-vitamins, and vitamin treatment has shown mixed results. Therefore, this review article has been conducted.

Does a low vitamin B level increase the risk of peripheral neuropathy?

Study design:
This review article included 46 observational studies and 7 interventional studies.

Results and conclusions:
The investigators found the presence of peripheral neuropathy was significantly associated with lowered B12 levels [1.51, 95% CI = 1.23 to 1.84, n = 34, I2 = 43.3%, p = 0.003].

The investigators found the presence of peripheral neuropathy was significantly associated with elevated methylmalonic acid levels [2.53, 95% CI = 1.39 to 4.60, n = 9, I2 = 63.8%, p = 0.005].

The investigators found the presence of peripheral neuropathy was significantly associated with elevated homocysteine levels [3.48, 95% CI = 2.01 to 6.04, n = 15, I2 = 70.6%, p 0.001].

The investigators found treatment with vitamin B1 was associated with a significant improvement in symptoms of peripheral neuropathy [5.34, 95% CI = 1.87 to 15.19, n = 3, I2 = 64.6%, p = 0.059].

The investigators found B12 treatment (vs. the comparators) showed a non-significant association with symptom improvement [1.36, 95% CI = 0.66 to 2.79, n = 4, I2 = 28.9%].

The investigators found analysis of 7 trials combined showed a non-significant higher odds ratio for improvement under treatment with the B-vitamins [2.58, 95% CI = 0.98 to 6.79, I2 = 80.0%, p 0.001].

The investigators concluded peripheral neuropathy is associated with lowered plasma vitamin B12 and elevated methylmalonic acid and homocysteine levels. Well-designed studies, especially in non-diabetes peripheral neuropathy, are needed.

Original title:
Association between neuropathy and B-vitamins: A systematic review and meta-analysis by Stein J, Geisel J and Obeid R.

Link:
https://pubmed.ncbi.nlm.nih.gov/33619867/

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Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased.

Increased methylmalonic acid levels are a sensitive indicator of mild vitamin B12 deficiency.
 

Objectives:
Does a low-carbohydrate diet (LCD) causally increase adiponectin concentration in adults?

Study design:
This review article included 11 RCTs with 534 participants in low-carbohydrate diet group and 513 participants in control group (group without a low-carbohydrate diet).
Proportion of carbohydrate from calorie was from 4 to 34% (4-34 En%).
Time of the follow-up varied between studies and ranged from 6 to 152 weeks.
Meta-regression analysis revealed that age [β = 0.04, p = 0.15], baseline BMI [β= -0.15, p = 0.15], time of follow-up [β = 0.01, p = 0.17], energy percentage of carbohydrates [β = 0.004, p = 0.90], energy percentage of protein [β = -0.12, p = 0.08], energy percentage of fat [β = 0.20, p = 0.61] and baseline adiponectin [β = 0.001, p = 0.97] are not sources of heterogeneity

Results and conclusions:
The investigators found low-carbohydrate diet significantly increased adiponectin concentration [0.02 µg/mL, 95% CI = 0.01 to 0.03, p 0.001].

The investigators found dose-response analysis indicated a nonlinear association between the percentage of carbohydrate and change in adiponectin level from baseline [p = 0.04].

The investigators found in subgroup analysis based on the proportion of carbohydrate from calorie, there was a significant increase in adiponectin concentration in studies that prescribed 30% of calorie from carbohydrates [0.12 µg/mL, 95% CI = 0.07 to 0.18].
In contrast, diets which consisted ≥30% of carbohydrates had no significant effect on adiponectin [0.50 µg/mL, 95% CI = -0.46 to 1.48].

The investigators concluded that a diet with 30% of calorie from carbohydrates (diet with 30 En% carbohydrates) causally increases adiponectin concentration in adults.

Original title:
Effect of low-carbohydrate diet on adiponectin level in adults: a systematic review and dose-response meta-analysis of randomized controlled trials by Shemirani F, Golzarand M, […], Mahmoudi M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33455438/

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The most easy way to follow a diet with maximum 30% of calorie from carbohydrates (diet with 30 En% carbohydrates) is to choose only meals/products with maximum 30 En% carbohydrates. Check here which products contain maximum 30 En% carbohydrates. However, the most practical way to follow a diet with maximum 30 En% carbohydrates is, all meals/products that you eat on a daily basis should on average contain maximum 30 En% carbohydrates.
30 En% carbohydrates means that the total amounts of carbohydrates make up for a 30% of the total kcal of the diet.

Adiponectin is a protein hormone produced and secreted exclusively by adipocytes (fat cells) that regulates the metabolism of lipids and glucose. Adiponectin influences the body's response to insulin. Adiponectin also has antiinflammatory effects on the cells lining the walls of blood vessels.
 

Objectives:
Fish oil has been shown to reduce the risk of metabolic disorders. However, the effects of fish oil intervention on glucose metabolism and insulin sensitivity are still controversial, especially in children. Therefore, this review article has been conducted.

Do fish oil supplements (EPA + DHA) improve insulin sensitivity in children?

Study design:
This review article included 13 RCTs with 567 children in placebo group (group without fish oil supplements) and 565 in fish oil group (intervention group).

No heterogeneity was found for the pooled and subgroup analyses.

Results and conclusions:
The investigators found compared with the placebo group, fish oil intervention had beneficial effects on insulin sensitivity in the pooled analysis [WMD = -0.219, 95% CI = -0.392 to -0.046, p = 0.013].

These beneficial effects were also found in subgroup analyses, when the fish oil intervention period was short-term (≤6 months) low dose (eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) dose 1.5 g/day) and high ratio (eicosapentaenoic acid to docosahexaenoic acid ≥1).

The investigators concluded fish oil supplements, especially 1.5 g/day EPA + DHA during 6 months, improve insulin sensitivity in children.

Original title:
Effect of Fish Oil on Insulin Sensitivity in Children: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials by Hou M, Zhou W, [...], Lv H.

Link:
https://pubmed.ncbi.nlm.nih.gov/33388274/

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Objectives:
Does type 1 diabetes mellitus (T1DM) decrease bone mineral density (BMD) in children and adolescents?

Study design:
This review article included 9 cross-sectional studies with a total of 1,522 children and adolescents.

Funnel plot and the Egger test did not reveal significant publication bias.

Results and conclusions:
The investigators found a significant decrease in bone mineral density Z-score in the whole body [pooled WMD = -0.47, 95% CI = -0.92 to -0.02, I2 = 80.2%] and lumbar spine [pooled WMD = -0.41, 95% CI = -0.69 to -0.12, I2 = 80.3%] in children and adolescents with type 1 diabetes mellitus, which was consistent in published studies from Asia and South America, but inconsistent in the North America and Europe.
Sensitivity analyses did not modify these findings.

The investigators found, importantly, the differences in bone mineral density Z-scores were independent of age, level of glucose control (HbA1c) and prepubertal stage.

The investigators concluded type 1 diabetes mellitus (T1DM) decreases bone mineral density (BMD) Z-scores in the whole body and lumbar spine in children and adolescents.

Original title:
Association between type 1 diabetes mellitus and reduced bone mineral density in children: a meta-analysis by Zhu Q, J Xu J, […], Shi J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33404757/  

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Objectives:
Fish oil supplementation has been shown to be associated with a lower risk of metabolic syndrome and benefit a wide range of chronic diseases, such as cardiovascular disease, type 2 diabetes and several types of cancers. However, the evidence of fish oil supplementation on glucose metabolism and insulin sensitivity is still controversial. Therefore, this review article (meta-analysis) has been conducted.

Does fish oil supplementation improve insulin sensitivity in humans?

Study design:
This review article included a total of 17 RCTs with 672 participants. One of the 17 studies was crossover design and others were parallel design.
The doses of active ingredients of fish oil (n-3 fatty acids) ranged from 1 g/d to 4 g/d. Duration of the interventions was ranged from 4 weeks to 24 weeks.
There was no suggestion of small study effect based on visual inspection of the funnel plot. Results of the Egger’s (p = 0.78) and Begg’s (p = 0.43) tests showed that there was no potential publication bias.

Results and conclusions:
The investigators found pooled analysis showed that fish oil supplementation had no effects on insulin sensitivity overall [SMD = 0.17, 95% CI = -0.15 to 0.48, p = 0.292, I2 = 58.1%, p = 0.001].

The investigators found subgroup analysis showed that fish oil supplementation significantly improved insulin sensitivity among people who were experiencing at least one symptom of metabolic disorders [SMD = 0.53, 95% CI = 0.17 to 0.88, p 0.001].

The investigators found subgroup analysis showed a positive effect of fish oil on insulin sensitivity among the short-term intervention group (12 weeks) rather than the long-term intervention group [SMD = 0.31, 95% CI = 0.01-0.61, p = 0.04].

The investigators found subgroup analysis showed that fish oil had no effects on insulin sensitivity among the healthy people or people with T2DM.

The investigators found there were no significant differences between subgroups of methods of insulin sensitivity and doses of omega-3 polyunsaturated fatty acids (n-3 PUFA) of fish oil supplementation.

The investigators found in sensitivity analysis that summary results did not differ significantly when omitting studies one at a time.

The investigators concluded that fish oil supplementation during 12 weeks improves insulin sensitivity among people who were experiencing at least one symptom of metabolic disorders.

Original title:
Fish oil supplementation and insulin sensitivity: a systematic review and meta-analysis by Gao H, Geng T, [...], Zhao Q.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496233/

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Objectives:
The potential glucose-lowering effects of pomegranate have been reported in animal and observational studies, but intervention studies in humans have generated mixed results. Therefore, this review article (meta-analysis) has been conducted.

What are the effects of pomegranate supplementation on measures of glucose control, insulin levels and insulin sensitivity in humans?

Study design:
This review article included 16 RCTs with 538 subjects. 14 trials adopted parallel study designs and the 2 remaining trials used crossover designs.
The total number of subjects included in each study ranged from 14 to 74 subjects.
The mean age of participants in each trial ranged from 30 to 70 years, with differing age ranges in most studies.
11 studies used pomegranate juice as a supplement (the dosage ranged from 120 to 500 ml/day).
2 studies used pomegranate seed oil as treatments (the dosage ranged from 400 to 2000 mg/day).
3 studies utilized pomegranate extract as the intervention (the dosage ranged from 710 to 1420 mg/day).  
The duration of the pomegranate intervention varied from 1 to 12 weeks (median: 5.5 weeks).

Overall, significant heterogeneity was detected for FBI and HOMA-IR, but subgroup analysis could not identify factors significantly influencing these parameters.
No significant publication bias was found.

Results and conclusions:
The investigators found that pomegranate did not significantly affect the measures of:
-FBG (fasting blood glucose) [WMD = -0.6 mg/dL, 95% CI = -2.79 to 1.58, p = 0.59, I2 = 0%];
-FBI (fasting blood insulin) [WMD = 0.29 μIU/mL, 95% CI = -1.16 to 1.75, p = 0.70, I2 = 60.4%];
-HOMA-IR (homeostatic model assessment of insulin resistance) [WMD = -0.04, 95% CI = -0.53 to 0.46, p = 0.88, I2 = 59.8%] or;
-HbA1c (glycated haemoglobin) [WMD = -0.11%, 95% CI = -0.39 to 0.18, p = 0.46, I2 = 0%].
These results were robust in sensitivity analysis.

The investigators found meta-regression analysis showed that the factor (dose of pomegranate juice supplementation) was not associated with the treatment effects on FBG level [coefficient = -0.006, 95% CI = -0.023 to 0.011, p = 0.46].

The investigators found no significant difference in the FBG-lowering effect between trials that were conducted in subjects with cardiovascular disease risk [WMD = 0.30 mg/dL, 95% CI = -2.36 to 2.97, p = 0.82] and those that were conducted in healthy individuals [WMD = -2.53 mg/dL, 95% CI = -6.36 to 1.30, p = 0.19].

The investigators found no statistically significant differences in the pooled effects of pomegranate on FBG in the subgroups stratified by study designs, intervention durations, types of intervention, baseline BMI and baseline FBG levels (FBG levels at the beginning of the studie).

The investigators concluded pomegranate supplements have no favourable effect on improvements in glucose and insulin metabolism. The current evidence suggests that daily pomegranate supplementation is not recommended as a potential therapeutic strategy in glycemic management. Further large-scale RCTs with longer duration are required to confirm these results.

Original title:
Lack of efficacy of pomegranate supplementation for glucose management, insulin levels and sensitivity: evidence from a systematic review and meta-analysis by Huang H, Liao D, […], Zhu Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629805/

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Objectives:
Do patients with type 2 diabetes benefit from a low carbohydrate diet?

Study design:
This review article included a total of 9 RCTs with 734 patients with type 2 diabetes.

Results and conclusions:
The investigators found that low carbohydrate diet significantly reduced HbA1c level [WMD = -0.44, 95% CI = -0.61 to -0.26, p= 0.00] of patients with type 2 diabetes.

The investigators found that low carbohydrate diet significantly reduced triglycerides concentration [WMD = -0.33, 95% CI = -0.45 to -0.21, p = 0.00] of patients with type 2 diabetes.

The investigators found that low carbohydrate diet significantly increased HDL cholesterol concentration (WMD = 0.07, 95% CI = 0.03 to 0.11, p = 0.00] of patients with type 2 diabetes.

The investigators found that low carbohydrate diet was not associated with decreased level of total cholesterol and LDL cholesterol.

The investigators found subgroup analyses showed that short term intervention of low carbohydrate diet was effective for weight loss [WMD = -1.18, 95% CI = -2.32 to -0.04, p = 0.04] in patients with type 2 diabetes.

The investigators concluded there is a beneficial effect of low carbohydrate diet intervention on glucose control in patients with type 2 diabetes. The low carbohydrate diet intervention also has a positive effect on triglycerides and HDL cholesterol concentrations, but without significant effect on long term weight loss.

Original title:
Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials by Meng Y, Bai H, […], Chen L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28750216

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A low carbohydrate diet is a diet that is largely made up of meals/products with 20-40 En% carbohydrate. Practically, this means that all meals/products that you eat on a daily basis should on average contain 20-40 En% carbohydrate.
20-40 En% carbohydrate means that the total amounts of carbohydrate make up for a 20-40% of the total kcal of the diet. Check here which products contain 20-40 En% carbohydrate.

Objectives:
Polyunsaturated fats (PUFAs) have been shown to reduce type 2 diabetes (T2DM) risk and improve insulin responsiveness in T2DM subjects, but whether the plant sources of omega-3 PUFA (alpha-linolenic acid [ALA]) have an effect on glycemic control requires further investigation. Therefore, this review article (meta-analysis) has been conducted.

Does alpha-linolenic acid dietary intake reduce diabetes risk?

Study design:
This review article included a total of 8 RCTs involving 212 participants with type 2 diabetes.
5 trials (62.5%) were parallel designs and 3 (37.5%) were crossover designs.
Participants were generally middle-aged (median age  =  54 years, range  =  47-64 years) and overweight or obese (median BMI  =  30.7, range  =  28.0-33.2).
Overall, participants had controlled diabetes (median HbA1c = 6.8%, median FBG = 7.95 mmol/L) and the majority of studies indicated the use of hypoglycemic drugs or other medications, although all studies excluded the use of insulin therapy.
The dose of ALA ranged from 1.5 to 7.4 g/day with a median assigned dose of 4.4, 5.4 and 5.4 g/day of ALA for trials that reported HbA1c, FBG and FBI, respectively.
The median duration of the treatment was 3 months, ranging from 2 to 12 months.
7 studies (87.5%) were considered high quality (MQS ≥8).

Results and conclusions:
The investigators found compared to a control diet, a median dose of 4.4 g/day of alpha-linolenic acid intake for a median duration of 3 months did not affect HbA1c (%) of patients with type 2 diabetes [MD =  -0.01, 95% = -0.32 to 0.31, p  =  0.96].

The investigators found compared to a control diet, a median alpha-linolenic acid dose of 5.4 g/day did not lower fasting blood glucose (FBG) of patients with type 2 diabetes [MD  = 0 .07, 95% CI = -0.61 to 0.76, p  = 0 .84] or fasting blood insulin (FBI) of patients with type 2 diabetes [MD  =  7.03, 95% CI = -5.84 to 19.89, p  = 0 .28].

The investigators found summary effect estimates were generally compromised by considerable and unexplained heterogeneity [I2 ≥ 75%].

The investigators found in the subgroup analysis of continuous predictors, a reduction in HbA1c (%) and FBG (mmol/L) was significantly associated with an increased intake of ALA.

The investigators found further adjustment for publication bias using Duval and Tweedie's trim-and-fill analysis provided an adjusted, significant MD of 0.25 [95% CI = -0.38 to -0.12, 0.001) for HbA1c (%).

The investigators concluded alpha-linolenic acid-enriched diet with a median alpha-linolenic acid dose of 4.4 g/day during 3 months has no effects on HbA1c, FBG or FBI in patients with type 2 diabetes. The scarce number of existing RCTs and the presence of heterogeneity in the meta-analysis limit the ability to make firm conclusions about alpha-linolenic acid in type 2 diabetes management. The potential for alpha-linolenic acid to have dose-dependent effects warrants further research in this area.

Original title:
The effect of alpha-linolenic acid on glycemic control in individuals with type 2 diabetes: A systematic review and meta-analysis of randomized controlled clinical trials by Jovanovski E1, Li D, […], Vuksan V.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457843/

Additional information of El Mondo:
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4.4 g/day alpha-linolenic acid can be achieved by taking 1 to 2 tablespoons of flax or salba-chia seeds or about 12 whole walnuts per day.

 

Objectives:
It has been unclear whether supplemental probiotics therapy improves clinical outcomes in type 2 diabetic patients. Therefore, this meta-analysis (systematic review) has been conducted.

Do probiotics supplements improve clinical outcomes in type 2 diabetic patients?

Study design:
This review article included 12 RCTs involving 684 type 2 diabetic patients.

Results and conclusions:
The investigators found a significant decreased glucose level in the probiotics group [pooled standardized mean difference = -0.18 mg/dL, 95% CI = -0.35 to -0.01, p = 0.04, I2 = 64%, p = 0.004] compared to the control group.

The investigators found a significant reduction in HbA1c in the probiotics group [pooled standardized mean difference = -0.38%, 95% CI = -0.62 to -0.14, p = 0.002, I2 = 0%, p = 0.72] compared to the control group.

The investigators found a significant reduction in fasting insulin level in the probiotics group [pooled standardized mean difference = -0.38, 95% CI = -0.59 to -0.18, p = 0.003, I2 = 0%, p = 0.81] compared to the control group.

The investigators found a significant reduced HOMA-IR level in the probiotics group [pooled standardized mean difference = -0.99, 95% CI = -1.52 to -0.4, p = 0.0002, I2 = 86%, p 0.00001] compared to the control group.

The investigators found a significant reduced CRP level in the probiotics group [pooled standardized mean difference = -1.34 mg/L, 95% CI = -1.76 to -0.92, p 0.00001, I2 = 90%, p 0.00001] compared to the control group.

The investigators found a non-significant reduction in both triglyceride levels [SMD = -0.23, 95% CI = -0.48 to 0.02, p = 0.07, I2 = 52%, p = 0.03] and cholesterol levels [total cholesterol: SMD = -0.18, 95% CI = -0.42 to 0.06, p = 0.14, I2 = 47%, p = 0.05 and LDL-cholesterol: SMD = -0.03, 95% CI = -0.20 to 0.14, p = 0.73, I2 = 3%, p = 0.41] in the probiotics group compared to the control group.

The investigators concluded that probiotics supplementation is associated with significant improvement in HbA1c and fasting insulin in type 2 diabetes patients. These results may provide evidence for encouraging use of probiotics in patients with type 2 diabetes mellitus. However, more randomized placebo-controlled trials with larger sample sizes are warranted to confirm these findings.

Original title:
Effect of Probiotics on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Meta-Analysis of 12 Randomized Controlled Trials by Yao K, Zeng L, [...], Zou X.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491138/

Additional information of El Mondo:
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Objectives:
What is the relationship between intake of 12 major food groups and risk of type 2 diabetes (T2D)?

Study design:
This review article included prospective cohort studies.
The 12 major food groups are whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat and sugar-sweetened beverages (SSB).

The meta-evidence was graded "low" for legumes and nuts; "moderate" for refined grains, vegetables, fruit, eggs, dairy and fish; and "high" for processed meat, red meat, whole grains and sugar-sweetened beverages.

Results and conclusions:
The investigators found 6 out of the 12 food-groups showed a significant relation with risk of type 2 diabetes; 3 of them a decrease of risk with increasing consumption (whole grains, fruits and dairy) and 3 an increase of risk with increasing consumption (red meat, processed meat and sugar-sweetened beverages) in the linear dose-response meta-analysis.

The investigators found evidence of a non-linear relationship between fruits, vegetables, processed meat, whole grains and sugar-sweetened beverages and type 2 diabetes risk.

The investigators found optimal consumption of risk-decreasing foods resulted in a 42% reduction and consumption of risk-increasing foods was associated with a threefold type 2 diabetes risk, compared to non-consumption.

The meta-evidence was graded "low" for legumes and nuts; "moderate" for refined grains, vegetables, fruit, eggs, dairy and fish; and "high" for processed meat, red meat, whole grains, and sugar-sweetened beverages. Among the investigated food groups, selecting specific optimal intakes can lead to a considerable change in risk of type 2 diabetes.

The investigators concluded that a higher consumption of whole grains, fruits and dairy products reduces type 2 diabetes risk, while a higher consumption of red meat, processed meat and sugar-sweetened beverages increases type 2 diabetes risk.

Original title:
Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies by Schwingshackl L, Hoffmann G, […], Boeing H.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28397016

Additional information of El Mondo:
Find more information/studies on consumption of meat, fruit, dairy products and nuts and type 2 diabetes right here.

Objectives:
Olive oil (OO) as food is composed mainly of fatty acids and bioactive compounds depending from the extraction method. Both had been discussed as health promoting with still open questions. Therefore, this meta-analysis (systematic review) has been conducted.

Does olive oil intake reduce risk of type 2 diabetes?

Study design:
This review article included 4 cohort studies including 15,784 type 2 diabetes cases and 29 intervention trials.

Results and conclusions:
The investigators found the highest olive oil intake category showed a 16% reduced risk of type 2 diabetes [RR = 0.84, 95% CI = 0.77, 0.92) compared with the lowest. The reduced risk was significant.

The investigators found evidence for a nonlinear relationship between olive oil intake and the reduced risk of type 2 diabetes.

The investigators found in patients with type 2 diabetes that olive oil supplementation resulted in a significantly more pronounced reduction in HbA1c [MD = -0.27%, 95% CI = -0.37 to -0.17] and fasting plasma glucose [MD = -0.44 mmol/L, 95% CI = -0.66 to -0.22] as compared with the control groups.

The investigators concluded that the intake of olive oil is beneficial for the prevention and management of type 2 diabetes. This conclusion regards olive oil as food and might not been valid for single components comprising this food.

Original title:
Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials by Schwingshackl L, Lampousi AM, […], Boeing H1.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28394365

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Objectives:
Nutrition therapy is an integral part of self-management education in patients with type 2 diabetes. Carbohydrates with a low glycemic index are recommended, but the ideal amount of carbohydrate in the diet is unclear. Therefore, this meta-analysis (systematic review) has been conducted.

Has carbohydrate restriction (below 45 En% carbohydrate) beneficial effects on glycemic control in type 2 diabetes?

Study design:
This review article included 10 RCTs. In total, 1,376 subjects with type 2 diabetes were included in this analysis. Forty-nine percent were male and the average age was 58 years. The majority were obese; mean BMI ranged from 26 kg/m² in an Asian population to 37 kg/m² in an American population.

The duration of the intervention varied from 3 to 24 months.

The average predefined targets for the assigned carbohydrate restriction were 25 En% (range 14-40 En%). The average reported intake was 30 En% (range 14-45 En%) after 3 or 6 months of intervention and 38 En% (range 27-45 En%) at 1 year (5 trials).

Results and conclusions:
The investigators found following a carbohydrate diet of 30 En% (range 14-45 En%) during 3 to 6 months significantly reduced HbA1c level of patients with type 2 diabetes with 0.34% [95% CI = 0.06 to 0.63] compared with a diet of 45-60 En% carbohydrate (high-carbohydrate diet).
Owing to heterogeneity, however, the quality of the evidence for this is only moderate. However, at 1 year or later, HbA1c level (seven trials included) was similar in the two groups.

The investigators found the greater the carbohydrate restriction, the greater the glucose-lowering effect [R = -0.85, p 0.01].

The investigators found the effect of the 2 types of diet on BMI/body weight, LDL cholesterol, QoL and attrition rate was similar throughout interventions.

The investigators concluded that carbohydrate restriction (below 45 En% carbohydrate) has a greater effect on glycemic control in type 2 diabetes than an high-carbohydrate diet in the short term. The magnitude of the effect was correlated to the carbohydrate intake, the greater the restriction, the greater glucose lowering, a relationship that has not been demonstrated earlier. However, in the long term, the glucose-lowering effect of high-carbohydrate diet (HCD) and low-carbohydrate diets (LCD) was similar.

Original title:
Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes by Snorgaard O, Poulsen GM, [...], Astrup A.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337734/

Additional information of El Mondo:
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Objectives:
Randomised controlled trials (RCTs) have observed contrasting results on the effects of vitamin C on circulating biomarkers of glycaemic and insulin regulation. Therefore, this meta-analysis (systematic review) has been conducted.

Has vitamin C supplementation a favorable effect on circulating biomarkers of glycaemic and insulin regulation?

Study design:
This review article included 22 RCTs with 937 participants.

Results and conclusions:
The investigators found overall, vitamin C supplementation did not modify glucose, HbA1c and insulin concentrations.

The investigators found, however, subgroup analyses showed that vitamin C supplementation significantly reduced glucose concentrations with 0.44 mmol/L [95% CI = -0.81 to -0.07, p =0.01] in patients with type 2 diabetes and in interventions with a duration greater than 30 days [-0.53%, 95% CI = -0.79 to -0.10, p = 0.02].

The investigators found vitamin C administration had greater effects on fasting [-13.63 pmol/L, 95% CI = -22.73 to -4.54, p 0.01] compared to postprandial insulin concentration. However, meta-regression analyses showed that age was a modifier of the effect of vitamin C on insulin concentration.

The investigators found the effect size of vitamin C supplementation was associated with baseline BMI and plasma glucose levels and with the duration of the intervention.

The investigators concluded vitamin C supplementation has greater reduction in glucose concentrations in patients with type 2 diabetes, older individuals and with more prolonged supplementation (greater than 30 days). Personalized interventions with vitamin C may represent a feasible future strategy to enhance benefits and efficacy of interventions. Nevertheless, results need to be interpreted cautiously due to limitations in the primary studies.

Original title:
Effects of vitamin C supplementation on glycaemic control: a systematic review and meta-analysis of randomised controlled trials by Ashor AW, Werner AD, […], Siervo M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28294172

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Objectives:
Does magnesium supplementation reduce risk of cardiovascular disease among diabetic subjects?

Study design:
This review article included RCTs.

Results and conclusions:
The investigators found magnesium supplementation significantly improved fasting plasma glucose with 4.641 mg/dL [WMD = -4.641 mg/dL, 95% CI = -7.602 to -1.680, p = 0.002]. A more beneficial effect of magnesium supplementation was observed in diabetic subjects with hypomagnesaemia.

The investigators found magnesium supplementation significantly improved high-density lipoprotein (HDL or good cholesterol) with 3.197 mg/dL [WMD = 3.197 mg/dL, 95% CI = 1.455 to 4.938, p 0.001]. A more beneficial effect of magnesium supplementation was observed in diabetic subjects with hypomagnesaemia.

The investigators found magnesium supplementation significantly improved low-density lipoprotein (LDL or bad cholesterol) with 10.668 mg/dL [WMD = -10.668 mg/dL, 95% CI = -19.108 to -2.228, p = 0.013]. A more beneficial effect of magnesium supplementation was observed in diabetic subjects with hypomagnesaemia.

The investigators found magnesium supplementation significantly improved plasma triglycerides with 15.323 mg/dL [WMD = -15.323 mg/dL, 95% CI = -28.821 to -1.826, p = 0.026]. A more beneficial effect of magnesium supplementation was observed in diabetic subjects with hypomagnesaemia.

The investigators found magnesium supplementation significantly improved systolic blood pressure with 3.056 mmHg [WMD = 3.056 mmHg, 95% CI = -5.509 to -0.603, p = 0.015]. A more beneficial effect of magnesium supplementation was observed in diabetic subjects with hypomagnesaemia.

The investigators concluded magnesium supplementation has a favourable effect on risk factors of cardiovascular diseases. Although future large RCTs are needed for making robust guidelines for clinical practice.

Original title:
Effect of magnesium supplementation on type 2 diabetes associated cardiovascular risk factors: a systematic review and meta-analysis by Verma H and Garg R.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28150351

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Objectives:
The conclusions from epidemiological studies are controversial between apple and pear consumption and type 2 diabetes mellitus (T2DM) risk. Therefore, this meta-analysis (systematic review) has been conducted.

Study design:
This review article included a total of 5 independent prospective cohort studies with 14,120 T2DM incident cases among 228,315 participants.

Results and conclusions:
The investigators found consumption of apples and pears was associated with 18% reduction in type 2 diabetes mellitus risk [multivariate-adjusted relative risk = 0.82, 95% CI = 0.75-0.88, I2 = 0.00%] when comparing the highest versus lowest category.

The investigators found dose-response analysis showed that one serving per week increment of apple and pear consumption was associated with a 3% [95% CI = 0.96-0.98, p for trend 0.001] reduction in type 2 diabetes mellitus risk.

The investigators concluded a higher consumption of apples and pears; at least one serving per week reduces type 2 diabetes mellitus risk.

Original title:
Apple and pear consumption and type 2 diabetes mellitus risk: a meta-analysis of prospective cohort studies by Guo XF, Yang B, […], Li D.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28186516

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The standard serving size is a 1/2 cup of sliced fruit. A medium pear produces approximately 1 cup of fruit; so an average medium pear equals two fruit servings.
1 small apple = 1 serving.