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Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

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Abstract

The aim of this study was to assess the effects of different dietary approaches on low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride (TG) levels in patients with type 2 diabetes (T2D) by applying network meta-analysis (NMA). Systematic electronic and hand searches were conducted until January 2018. Randomized controlled trials (RCTs) with an intervention period of ≥ 12 weeks, focussing on adults with T2D, and comparing dietary approaches regarding LDL, HDL or TGs, were included. For each outcome measure, random effects NMA was performed in order to determine the effect of each dietary approach compared to every other dietary intervention. Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated, and for the ranking, the surface under the cumulative ranking curves (SUCRA) was determined. Additionally, the credibility of evidence was evaluated. 52 RCTs (44 for LDL, 48 for HDL and 52 for TGs) comparing nine dietary approaches (low fat, vegetarian, Mediterranean, high protein, moderate carbohydrate, low carbohydrate, control, low glycaemic index/glycaemic load and Palaeolithic diet) enrolling 5360 T2D patients were included. The vegetarian diet most effectively reduced LDL levels [MD (95% CI): − 0.33 (− 0.55, − 0.12) mmol/L; compared to the control diet]. The Mediterranean diet beneficially raised HDL [MD (95% CI): 0.09 (0.04, 0.15) mmol/L] and decreased TG levels [MD (95% CI): − 0.41 (− 0.72, − 0.10) mmol/L] compared to the control diet. The Mediterranean diet was the most effective dietary approach to manage diabetic dyslipidaemia altogether (SUCRA: 79%). The overall findings are mainly limited by low credibility of evidence.

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Acknowledgements

We thank Pamela Dyson, Ph.D. RD and Robyn Larsen, Ph.D. for sending additional data for the corresponding meta-analysis.

Funding

The German Diabetes Center (DDZ) is funded by the German Federal Ministry of Health and the Ministry of Innovation, Science, Research and Technology of the State North Rhine-Westphalia.

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Author notes

  1. Lukas Schwingshackl and Sabrina Schlesinger have contributed equally to this work.

Authors and Affiliations

  1. Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany

    Manuela Neuenschwander & Sabrina Schlesinger

  2. Department of Nutritional Sciences, University of Vienna, Vienna, Austria

    Georg Hoffmann

  3. Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Straße 153, 79110, Freiburg, Germany

    Lukas Schwingshackl

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  1. Manuela Neuenschwander
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  4. Sabrina Schlesinger
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Contributions

LS, SS contributed to the conception and design of the systematic review and meta-analysis. LS, MN, GH were involved in the acquisition and analysis of the data. LS, SS, MN interpreted the results. LS, SS, MN drafted this manuscript. All authors provided critical revisions of the protocol and approved submission of the final manuscript.

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Correspondence to Lukas Schwingshackl.

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Neuenschwander, M., Hoffmann, G., Schwingshackl, L. et al. Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Eur J Epidemiol 34, 837–852 (2019). https://doi.org/10.1007/s10654-019-00534-1

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