Nutritional advice

Objectives:
Type 1 diabetes mellitus (T1DM) causes the irreversible destruction of pancreatic beta cells. The Bacillus Calmette-Guerin (BCG) vaccine can modulate the immune response and decelerate disease progression. Therefore, this review article has been conducted.

Do patients with type 1 diabetes mellitus benefit from the Bacillus Calmette-Guerin (BCG) vaccine?

Study design:
This review article included 4 RCTs. The sample sizes ranged from 6 to 94, with a total of 198 subjects. The mean age of the examinees ranged from 10.1 to 36.0 years and the follow-up duration ranged from 1 to 8 years.

Results and conclusions:
The investigators found the pooled meta-analysis demonstrated no significant difference in HbA1c levels [MD = -0.12, 95% CI = -0.53 to 0.30, I2 = 56%] or fasting C-peptide levels [MD = -0.15, 95% CI = -0.35 to 0.06, I2 = 0%] in the BCG intervention group as compared with that in the placebo group.
The results remained unchanged after removing each study in the sensitivity analysis.

The investigators concluded there is no robust evidence to support the use of the Bacillus Calmette-Guerin (BCG) vaccine for the treatment of type 1 diabetes mellitus although the HbA1c levels tend to improve. Additional RCTs to assess the long-term effects of the Bacillus Calmette-Guerin (BCG) vaccine on glycemic control are warranted.

Original title:
Therapeutic Effects of BCG Vaccination on Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Chang YC, Lin CJ, […], Hsu HY.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139880/

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Objectives:
Does fish consumption reduce risk of coronary heart disease (CHD), stroke and all-cause mortality in patients with type 2 diabetes (T2D)?

Study design:
This review article included 9 prospective cohort studies with 57,394 diabetic patients.

Results and conclusions:
The investigators found for the highest compared with the lowest category of fish consumption, a significantly reduced risk of 14% [relative risk = 0.86, 95% CI = 0.76 to 0.96, I2 = 50%, n = 8] for all-cause mortality in patients with type 2 diabetes.

The investigators found for the highest compared with the lowest category of fish consumption, a significantly reduced risk of 39% [relative risk = 0.61, 95% CI = 0.29 to 0.93, I2 = 68%, n = 3] for coronary heart disease in patients with type 2 diabetes.

The investigators found there was a monotonic inverse association, with a nadir at fish consumption of approximately 2-3 servings/week, in both analyses.

The investigators concluded 2-3 servings/week of fish consumption reduce risk of all-cause mortality and coronary heart disease in patients with type 2 diabetes.

Original title:
Fish consumption and the risk of cardiovascular disease and mortality in patients with type 2 diabetes: a dose-response meta-analysis of prospective cohort studies by Jayedi A, Soltani S, […], Shab-Bidar S.

Link:
https://pubmed.ncbi.nlm.nih.gov/32410513/

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Objectives:
Does niacin (vitamin B3) supplementation improve lipid profiles and glycemic control in patients with type 2 diabetes mellitus?

Study design:
This review article included 8 RCTs comprised a total of 2,110 patients with type 2 diabetes mellitus.
Studies published ranged from 1990 to 2016 and 15 to 1,053 patients were included in each individual trial.

The follow-up duration ranged from 8.0 weeks to 12.0 months.

The study quality was assessed using the Jadad scale. 4 studies had 3 scores and the remaining 4 studies had 2 scores.

There was no significant publication bias.

Results and conclusions:
The investigators found patients’ niacin supplementation was associated with lower levels of total cholesterol [WMD = -0.28, 95% CI = -0.44 to -0.12, p =  0.001], triglyceride [WMD = -0.37, 95% CI = -0.52 to -0.21, p   0 .001] and low-density lipoprotein cholesterol (bad cholesterol) [WMD = -0.42, 95% CI = -0.50 to -0.34, p    0.001].

The investigators found, moreover, the level of high-density lipoprotein cholesterol (good cholesterol) was significantly increased when niacin supplementation [WMD = 0.33, 95% CI = 0.21 to 0.44, p 0 .001] was provided.

The investigators found, however, niacin supplementation produced no significant effects on plasma glucose [WMD = 0.18, 95% CI = -0.14 to 0.50, p = 0 .275] and hemoglobin A1c (HbA1c) levels [WMD = 0.39, 95% CI = -0.15 to 0.94, p = 0 .158].

The investigators concluded that niacin (vitamin B3) supplementation improves lipid profiles, including total cholesterol, LDL and HDL cholesterol without affecting the glycemic levels for patients with type 2 diabetes mellitus. Additional large-scale RCTs should be conducted to evaluate the long-term effectiveness of niacin supplementation.

Original title:
Effectiveness of niacin supplementation for patients with type 2 diabetes: A meta-analysis of randomized controlled trials by Xiang D, Zhang Q and Wang YT.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373507/

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Objectives:
Type 2 diabetes mellitus is a chronic disease that occurs among the general population. The insulin-lowering and homeostasis model assessment of insulin resistance-improving effects of inulin are unconfirmed. Therefore, this review article has been conducted.

Do inulin supplements improve HOMA-IR, fasting plasma glucose and HbA1c in patients with type 2 diabetes mellitus?

Study design:
This review article included 9 RCTs with a total of 661 participants.

The duration of the interventions ranged from 6 weeks to 12 weeks and the dosage of inulin supplementation ranged from 8.4 g to 10 g per day.

Results and conclusions:
The investigators found inulin supplementation significantly improved fasting plasma glucose [SMD = -0.55, 95% CI = -0.73 to -0.36, p = 0.0], HOMA-IR [SMD = -0.81, 95% CI = -1.59 to -0.03, p = 0.042] and HbA1c [SMD = -0.69, 95% CI = -0.92 to -0.46, p = 0.0] in patients with type 2 diabetes mellitus.

The investigators found, further subgroup analyses revealed a significant role of inulin supplementation for treatment durations ≥8 weeks [p = 0.038 for insulin, p = 0.002 for HOMA-IR, p = 0.032 for fasting plasma glucose, p = 0 for HbA1c] in patients with type 2 diabetes mellitus.

The investigators concluded that daily 8.4-10 grams of inulin supplements for at least 8 weeks improve HOMA-IR, fasting plasma glucose and HbA1c in patients with type 2 diabetes mellitus.

Original title:
Efficacy of inulin supplementation in improving insulin control, HbA1c and HOMA-IR in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials by Zhang W, Tang Y, […], Hu H.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263925/

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Inulin is a type of fiber that's found in certain plant foods. Chicory root is the main source of inulin in supplement form.

Objectives:
Antioxidant status is considered as important factor in the pathogenesis (the manner of development of a disease) of vitiligo. However, there are controversial findings about serum status of antioxidants in vitiligo patients. Therefore, this review article has been conducted.

Is there a relationship between serum antioxidant level (e.g. vitamin C, E, zinc and selenium) and risk of vitiligo?

Study design:
This review article included 11 studies including 570 vitiligo cases and 580 controls (people without vitiligo).

Serum vitamin A and copper level in vitiligo patients were only evaluated in single studies and not included in meta-analysis.

Results and conclusions:
The investigators found based on fixed effect model, there were no statistical difference between two groups regarding serum vitamin C levels [OR = 1.17, 95% CI = 0.74 to 1.84, p = 0.495] and serum vitamin E levels [OR = 0.61, 95% CI = 0.30 to 1.25, p = 0.180].

The investigators found in sensitivity analysis, higher serum zinc levels significantly decreased risk of vitiligo with 71% [OR = 0.29, 95% CI = 0.15 to 0.54, p 0.001].

The investigators found in sensitivity analysis, higher serum selenium level significantly increased risk of vitiligo with 331% [OR = 4.31, 95% CI = 2.72 to 6.81, p 0.001].

The investigators concluded that higher serum selenium and lower zinc level increase risk of vitiligo. Potential mechanism associated with preventive effects of zinc and the depigmentation effect of selenium should be more elucidated in further studies.

Original title:
Serum Level of Antioxidant Vitamins and Minerals in Patients With Vitiligo, a Systematic Review and Meta-Analysis by Huo J, Liu T, [...], Wang R.

Link:
https://pubmed.ncbi.nlm.nih.gov/32593085/

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Vitiligo is a long-term condition where pale white patches develop on the skin. It's caused by the lack of melanin, which is the pigment in skin. Vitiligo can affect any area of skin, but it commonly happens on the face, neck and hands and in skin creases.

Objectives:
Does barberry (Berberis vulgaris L.) supplementation improve glycemic markers including fasting blood sugar (FBS) concentrations, insulin levels, homeostatic model assessment for insulin resistance (HOMA-IR) and glycosylated hemoglobin (HbA1c) percentage?

Study design:
This review article included 7 RCTs, comprising 452 participants.

Results and conclusions:
The investigators found the meta-analysis revealed that barberry supplementation significantly reduced insulin levels [Hedges’s = -0.67, 95% CI = -1.31 to -0.03, p = 0.04, I2 = 73.3%].
However, no significant positive effect was observed for fasting blood sugar levels [WMD = -8.06 mg/dL, 95% CI = -20.46 to 4.33, p = 0.23, I2 = 96.1%], HbA1c percentage [WMD = -0.83%, 95% CI = -2.33 to 0.67, p = 0.27, I2 = 88.3%] and HOMA-IR index [WMD = -0.55, 95% CI = -1.60 to 0.50, p = 0.30, I2 = 99.4%].

The investigators concluded barberry supplementation improves insulin levels.

Original title:
The Effect of Barberry (Berberis Vulgaris L.) on Glycemic Indices: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Safari Z, Farrokhzad A, […], Askari G.

Link:
https://www.sciencedirect.com/science/article/abs/pii/S0965229920302235?via%3Dihub

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Objectives:
A low insulin-like growth factor 1 (IGF-1) level is known to be associated with many disorders. Several studies have shown that soy consumption may influence IGF-1, but the findings remain inconclusive. Therefore, this review article (meta-analysis) has been conducted.

Does soy consumption increase insulin-like growth factor 1 (IGF-1) level?

Study design:
This review article included 8 clinical trials.

Results and conclusions:
The investigators found, overall, a significant increment in plasma IGF-1 was observed following soy intervention [WMD = 13.5 ng/mL, 95% CI = 5.2 to 21.8, I2 = 97%].

The investigators found, subgroup analyses demonstrated a significantly greater increase in IGF-1, when soy was administered at a dosage of ≤40 g/day [WMD = 11.7 ng/mL, 95% CI = 10.9 to 12.6, I2 = 98%] and when the intervention duration was 12 weeks [WMD = 26.6 ng/mL, 95% CI = 9.1 to 44.1, I2 = 0.0%].

The investigators found, in addition, soy intervention resulted in a greater increase in IGF-1 among non-healthy subjects [WMD = 36 ng/mL, 95% CI = 32.7 to 39.4, I2 = 84%] than healthy subjects [WMD = 9.8 ng/mL, 95% CI = 8.9 to 10.7, I2 = 90%].

The investigators concluded ≤40 grams of soy consumption per day during 12 weeks increase the IGF-1 level.

Original title:
The Effect of Soy Intervention on Insulin-Like Growth Factor 1 Levels: A Meta-Analysis of Clinical Trials by Jiawei Zeng J, Feng Y, […], Chen X.

Link:
https://pubmed.ncbi.nlm.nih.gov/32072706/

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Objectives:
Does high magnesium dietary intake reduce risk of type 2 diabetes and stroke?

Study design:
This review article included 53 prospective cohort studies with a total of 1,912,634 participants and 76,678 cases (persons with type 2 diabetes or stroke).

Participants were predominately middle aged at baseline (at the beginning of the studies), with a mean magnesium intake of 370 mg/day for the highest category and 232 mg/day for the lowest category.

The mean duration of all eligible studies was 10.7 years.

Results and conclusions:
The investigators found, when comparing the highest category of magnesium dietary intake (370 mg/day) to the lowest (232 mg/day), a significantly reduced risk of 22% [RR = 0.78, 95% CI = 0.75 to 0.81, p 0.001, I2 = 35.6%, p = 0.021] for type 2 diabetes.

The investigators found, when comparing the highest category of magnesium dietary intake (370 mg/day) to the lowest (232 mg/day), a significantly reduced risk of 11% [RR = 0.89, 95% CI = 0.83 to 0.94, p 0.001, I2 = 0%, p = 0.529] for total stroke.

The investigators found, when comparing the highest category of magnesium dietary intake (370 mg/day) to the lowest (232 mg/day), a significantly reduced risk of 12% [RR = 0.88, 95% CI = 0.81 to 0.95, p = 0.001, I2 = 16.9%, p = 0.265] for ischaemic stroke.

The investigators found in studies adjusted for cereal fiber dietary intake, a significantly reduced risk of 21% [RR = 0.79, 95% CI = 0.73 to 0.85, p 0.001] for type 2 diabetes.

The investigators found in studies adjusted for calcium dietary intake, a significantly reduced risk of 11% [RR = 0.89, 95% CI = 0.80 to 0.99, p = 0.040] for total stroke.

The investigators found in stratified analyses by characteristics of the population and study design, a significantly reduced risk of 9% [RR = 0.91, 95% CI = 0.83 to 0.99] for total stroke among female.

The investigators found in stratified analyses by characteristics of the population and study design, a significantly reduced risk of 11% [RR = 0.89, 95% CI = 0.79 to 1.00] for ischaemic stroke among female.

The investigators found in stratified analyses by characteristics of the population and study design, a significantly reduced risk of 11% [RR = 0.89, 95% CI = 0.82 to 0.96] for total stroke among individuals with BMI ≥25 kg/m².

The investigators found in stratified analyses by characteristics of the population and study design, a significantly reduced risk of 12% [RR = 0.88, 95% CI = 0.81 to 0.96] for ischaemic stroke among individuals with BMI ≥25 kg/m².

The investigators found in stratified analyses by characteristics of the population and study design, a significantly reduced risk of 11% [RR = 0.89, 95% CI = 0.83 to 0.95] for total stroke among studies wtith ≥12-year follow-up.

The investigators found in stratified analyses by characteristics of the population and study design, a significantly reduced risk of 12% [RR = 0.88, 95% CI = 0.81 to 0.95] for ischaemic stroke among studies wtith ≥12-year follow-up.

The investigators found for every 100 mg/day increment of magnesium dietary intake, a significantly reduced risk of 6% [RR = 0.94, 95% CI = 0.93 to 0.95] for type 2 diabetes.

The investigators found for every 100 mg/day increment of magnesium dietary intake, a significantly reduced risk of 2% [RR = 0.98, 95% CI = 0.97 to 0.99] for total stroke.

The investigators found for every 100 mg/day increment of magnesium dietary intake, a significantly reduced risk of 2% [RR = 0.98, 95% CI = 0.97 to 0.99] for ischaemic stroke.

The investigators concluded magnesium dietary intake has a substantial inverse association with type 2 diabetes and (total/ ischaemic) stroke. Furthermore, female, participants with obesity (BMI ≥ 25 kg/m²) and with a longer follow-up period (≥12 years) obtain greater benefit from magnesium intake with a lower risk of total and ischaemic stroke incidence. Overall, these findings support the guidelines to address the role of magnesium dietary intake in early prevention strategies to combat type 2 diabetes and stroke. However, additional RCTs are needed in the future to validate the causality.

Original title:
Association of magnesium intake with type 2 diabetes and total stroke: an updated systematic review and meta-analysis by Zhao B, Zeng L, [...], Zhang W.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103847/

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Objectives:
Is there an association between total meat, red meat, processed meat, poultry and fish intake and risk of type 2 diabetes (T2D)?

Study design:
This review article included 28 prospective cohort studies.

Results and conclusions:
The investigators found when compared with the lowest category, the highest category of total meat intake, significantly increased risk of type 2 diabetes with 33% [summary relative risk = 1.33, 95% CI = 1.16 to 1.52].
Significantly means that there is an association with a 95% confidence.

The investigators found when compared with the lowest category, the highest category of red meat intake, significantly increased risk of type 2 diabetes with 22% [summary relative risk = 1.22, 95% CI = 1.16 to 1.28].
Significantly because summary relative risk of 1 was not found in the 95% CI of 1.16 to 1.28. Summary relative risk of 1 means no risk/association.

The investigators found when compared with the lowest category, the highest category of processed meat intake, significantly increased risk of type 2 diabetes with 25% [summary relative risk = 1.25, 95% CI = 1.13 to 1.37].
Significantly means it can be said with a 95% confidence that the highest category of processed meat intake really increased risk of type 2 diabetes with 25%.

The investigators found no association between highest category of poultry intake and risk of type 2 diabetes [summary relative risk = 1.00, 95% CI = 0.93 to 1.07].
No association because summary relative risk of 1 was found in the 95% CI of 0.93 to 1.07. Summary relative risk of 1 means no risk/association.

The investigators found no association between highest category of fish intake and risk of type 2 diabetes [summary relative risk = 1.01, 95% CI = 0.93 to 1.10].

The investigators found in the dose-response analysis, each additional 100g/day of total and red meat and 50g/day of processed meat, were found to be associated with a 36% [95% CI = 1.23 to 1.49], 31% [95% CI = 1.19 to 1.45] and 46% [95% CI = 1.26 to 1.69] increased risk of type 2 diabetes, respectively.

The investigators found, in addition, there was evidence of a non-linear dose-response association between processed meat and type 2 diabetes [p = 0.004], with the risk increasing by 30% with increasing intakes up to 30g/day.

The investigators concluded 100g/day of total meat, 100g/day red meat and 50g/day of processed meat, increase risk of type 2 diabetes.

Original title:
Meat and fish intake and type 2 diabetes: dose-response meta-analysis of prospective cohort studies by Yang X, Li Y, […], Li L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32302686

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Objectives:
Is there a causal relationship between psyllium (a dietary fiber) consumption and improvements of risk factors of diabetes?

Study design:
This review article included 9 RCTs with 395 participants.

Results and conclusions:
The investigators found psyllium consumption significantly reduced triglycerides levels with 19.18 mg/dL [WMD = -19.18 mg/dL, 95% CI = -31.76 to -6.60, I2 = 98%].

The investigators found psyllium consumption significantly reduced low-density lipoprotein cholesterol levels with 8.96 mg/dL [WMD = -8.96 mg/dL, 95% CI = -13.39 to -4.52, I2 = 97%].

The investigators found psyllium consumption significantly reduced fasting blood sugar levels with 8.96 mg/dL [WMD = -31.71 mg/dL, 95% CI = -50.04 to -13.38, I2 = 97%].

The investigators found psyllium consumption significantly reduced hemoglobin A1c levels with 0.91% [WMD = -0.91%, 95% CI = -1.31 to -0.51, I2 = 99%].

The investigators found no significant change in high-density lipoprotein, body mass index, cholesterol and weight following psyllium consumption.

The investigators concluded there is a significant reduction in triglycerides, low-density lipoprotein cholesterol (bad cholesterol), fasting blood sugar and hemoglobin A1c levels following psyllium consumption among diabetic patients.

Original title:
The effect of psyllium consumption on weight, body mass index, lipid profile, and glucose metabolism in diabetic patients: A systematic review and dose-response meta-analysis of randomized controlled trials by Xiao Z, Chen H, [...], Wei Y.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31919936

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Psyllium is a form of fiber made from the husks of the Plantago ovata plant’s seeds. The psyllium husk is a naturally occurring source of soluble fiber.
Psyllium is commonly found in cereals, dietary supplements and is also added to some foods including baked products such as breads, cereal bars and rice/grain cakes.
 

Objectives:
Previous findings on the associations of legume and soy intake with the risk of type 2 diabetes are conflicting. Therefore, this review article (meta-analysis) has been conducted.

Does legume or soy dietary intake reduce risk of type 2 diabetes?

Study design:
This review article included 15 unique cohort studies with a total of 565,810 individuals and 32,093 incident cases (persons with type 2 diabetes).

Overall quality of evidence was rated as moderate for total legumes and low for total soy and soy subtypes.

Results and conclusions:
The investigators found no association between total legumes dietary intake and risk of type 2 diabetes [summary RR = 0.95, 95% CI = 0.79 to 1.14, I2 = 84.8%].
No association because RR of 1 was found in the 95% CI of 0.79 to 1.14. RR of 1 means no risk/association.

The investigators found no association between total soy dietary intake and risk of type 2 diabetes [summary RR = 0.83, 95% CI = 0.68 to 1.01, I2 = 90.8%].

The investigators found no association between soy milk dietary intake and risk of type 2 diabetes [summary RR = 0.89, 95% CI = 0.71 to 1.11, I2 = 91.7%].

The investigators found tofu dietary intake significantly reduced risk of type 2 diabetes with 8% [summary RR = 0.92, 95% CI = 0.84 to 0.99].
Significantly because RR of 1 was not found in the 95% CI of 0.84 to 0.99. RR of 1 means no risk/association.

The investigators found soy protein dietary intake significantly reduced risk of type 2 diabetes with 16% [summary RR = 0.84, 95% CI = 0.75 to 0.95].

The investigators found soy isoflavones dietary intake significantly reduced risk of type 2 diabetes with 12% [summary RR = 0.88, 95% CI = 0.81 to 0.96].

The investigators found in dose-response analysis, significant linear inverse associations for tofu, soy protein and soy isoflavones [all p 0.05].

The investigators concluded dietary intakes of tofu, soy protein and soy isoflavones reduce incident type 2 diabetes. These findings support recommendations to increase intakes of certain soy products for the prevention of type 2 diabetes. However, the overall quality of evidence was low and more high-quality evidence from prospective studies is needed.

Original title:
Legume and soy intake and risk of type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies by Tang J, Wan Y, […], Feng F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31915830

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