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Eating a diet rich in whole grains, fiber, fish, and polyunsaturated fatty acids (PUFAs) may reduce the risk of death from all causes in adults with type 2 diabetes (T2D), according to a systematic review and meta-analysis synthesising all available evidence, which was presented At this year’s European Association for the Study of Diabetes (EASD) annual meeting in Stockholm, Sweden (September 19-23).

“There are some dietary recommendations and guidelines for people with type 2 diabetes, but most are not based on evidence or derived from studies in the general population,” says lead author Dr. Janet Barbarescu of the German Diabetes Center in Dusseldorf, Germany. “Our careful assessment of the best evidence currently available with a reasonable degree of certainty indicates that a diet rich in whole grains, fiber, fish, and PUFAs as well as consuming more vegetables and plant proteins may help people with type 2 diabetes live longer.”

However, the researchers stress that the limited evidence about other dietary factors, including dietary patterns, foods such as dairy, meat, and tea, and micronutrients such as caffeine and vitamin D, underscore the need for more robust and comprehensive studies for a better understanding. Effect of various dietary factors on the development of T2D.

People with T2D have a higher risk of circulatory disease, dementia, cancer, and bone fractures. And despite the growing number of effective medications, lifestyle modifications — such as exercise and diet — remain the cornerstones of treatment.

However, little is known about diet and the prevention of disease and death in people with T2D. Some studies have assessed the association between specific dietary factors such as the Mediterranean diet or vegetable intake on all-cause mortality in T2D, but the relationship with different dietary factors has not been comprehensively summarized.

To learn more, German researchers conducted a systematic review of 107 prospective observational studies looking at any dietary factors (such as dietary patterns, foods and food groups, macronutrients. [carbohydrates, fats, protein] and micronutrients [minerals and vitamins] Secondary plant compounds [e.g., polyphenols]and nutritional supplements [e.g., vitamin E, magnesium]and risk of death from all causes in adults (aged 18 years or older) with T2D, through June 2022.

Overall, 72 studies were included in 45 meta-analyses to compare the effects of high versus low intake and to assess the dose-response relationship between dietary factors and death from any cause, over an average of 10 years. The number of participants included in the meta-analyses ranged from 1,073 to 84,816. The certainty of the evidence was assessed to determine confidence in the meta- results [1].

The analyzes found that there was moderate certainty of evidence for a protective association between intake of whole grains, fiber, fish, n-3 PUFAs and death from all causes. Adding one serving (20g/day) of whole grains from foods such as brown bread, rice or breakfast cereals was associated with a reduction of about 16%. Each serving of increased fish consumption per week was associated with a 5% lower risk of death.

Similarly, an additional 5 g per day intake of dietary fiber (equivalent to a medium pear or harvested wheat) and a 0.1 g per day increase in n-3 PUFAs were associated with a reduced risk of death from all causes – 14% and 13% lower, respectively. The body does not produce n-3 fatty acids naturally, so good sources include fish, vegetable oils, nuts (especially walnuts), flaxseeds, flaxseed oil, and leafy green vegetables.

Evidence with low certainty also suggests that higher intakes of vegetables and plant proteins may be beneficial. A daily increase of 100g of vegetables and 10g of vegetable proteins such as nuts, tofu, beans, lentils and peas was associated with a 12% and 9% lower risk of death, respectively.

Potential beneficial effects of these foods include their association with positive changes in blood pressure, cholesterol, blood sugar levels, and anti-inflammatory effects, which may help reduce the risk of comorbidities such as cardiovascular disease and cancer.

By contrast, higher egg intake and dietary cholesterol were associated with an increased risk of death from any cause – an increase in egg intake of 10 g per day (equivalent to two medium eggs per week) was associated with a 5% increased risk. death, while supplementing with 300 mg of dietary cholesterol per day was associated with an increase of 19%.

For other dietary factors, no association was found and/or the evidence was very uncertain, including: dietary patterns such as the Mediterranean diet and the low-carbohydrate high-protein diet; foods including nuts, dairy products, meat, sugar, and sweets; Macronutrients including carbohydrates and micronutrients such as caffeine and vitamin D.

Dr. Sabrina Schlesinger at the German Diabetes Center in Dusseldorf and the German Center for Diabetes Research (DZD) in Munich-Neuerberg (partner in Düsseldorf), who led the study, says. “But if individuals with type 2 diabetes are able to add a few servings of whole grains, fibre, fish, vegetable oils and vegetables to their weekly diets, our results suggest that it may be an easy, low-risk way to improve their outcomes.”

The authors note that the study is observational and therefore does not prove that people with T2D who follow a diet rich in whole grains, fiber, fish, and n-3 PUFAs will live longer. Instead, it shows a link. They also note that the small number of studies in many meta-analyses may limit the conclusions that can be drawn.

For interviews with the authors of the report, please contact Dr. Olaf Sporkel at the press office of the German Diabetes Center, Düsseldorf, Germany E) olaf.spoerkel@ddz.de Tel: +49 211 3382-507

Alternative contact in the EASD press room: Tony Kirby T) + 44 (0) 7834 385827 E) tony@tonykirby.com

Notes to editors:

[1] The certainty of the evidence was assessed using the GRADE approach that takes into account risk of within-study bias, inconsistency, indirectness, inaccuracy between studies, publication bias, effect size, response, and dose relationship. A high degree of certainty of the evidence indicates that there is high confidence in the effect estimate and that further research probably will not change the effect estimate, while moderate certainty of the evidence indicates moderate confidence in the effect estimate and other studies may change the effect estimate. Low certainty of evidence indicates low confidence in the effect estimate and other studies are likely to alter the effect estimate, and very low certainty of evidence indicates that there is very limited and uncertain meta-evidence.

The German Diabetes Center is funded by the German Federal Ministry of Health and the Ministry of Science and Culture of the state of North Rhine-Westphalia. The study was supported in part by the German Center for Diabetes Research (DZD). The funders had no role in the study design or data collection, analysis and interpretation.

The authors declared that there was no difference in interests.

This press release is based on the European Association for the Study of Diabetes (EASD) 1 oral presentation. All widely accepted abstracts were reviewed by the conference selection committee. There is no complete research paper at this point, but the authors are happy to answer your questions. The research has been submitted to a medical journal for publication. Since it is an oral presentation, there is no label for this talk.