Stockholm, Sweden – New data shows that higher consumption of whole grains, fish, fiber and omega-3 polyunsaturated fatty acids reduces all-cause mortality in people with type 2 diabetes.
The results of the systematic review and meta-analysis were presented here at this year’s European Association for the Study of Diabetes (EASD) annual meeting by lead author Janet Barbarescu, PhD, a researcher from the German Diabetes Center in Dusseldorf.
Adding just one serving (about 20 g/day) of whole grains from foods such as brown bread, brown rice or breakfast cereals was associated with a decrease of about 16% in all-cause mortality, with every portion of fish consumed weekly. Associated with a 5% lower risk of all-cause mortality. Also, an intake of 5 g/day of fiber was associated with a 14% reduction in all-cause mortality, and 0.1 g/day of omega-3 polyunsaturated fatty acids with a 13% reduction.
Diet also has a role in improving survival in people with type 2 diabetes
Barbarescu explained that most dietary recommendations for people with type 2 diabetes are not evidence-based, or derived from studies in the general population, and that the degree to which the various components of the diet are associated with all-cause mortality, or indeed prevention. Morbidity, mortality, unknown.
For example, she referenced the American Diabetes Association 2022 guiding rules To prevent and treat complications of diabetes it is recommended to eat limited amounts of saturated and trans fatty acids, increase the intake of polyunsaturated fatty acids, and follow the Mediterranean diet or the DASH (Dietary Approaches to Stop Hypertension) diet.
“Our findings show that dietary factors not only play a role in preventing type 2 diabetes, but also appear to be related to improving survival in people with diabetes,” she said, adding that “in particular, we found Some key aspects of a healthy diet such as higher intakes of whole grains, fiber, fish, and omega-3 polyunsaturated fatty acids may improve survival for individuals with type 2 diabetes.”
She noted that individuals with type 2 diabetes are known to have a higher risk of circulatory disease, dementia, cancer and bone fractures, and that lifestyle modifications, including diet — with or without medications — support most management strategies.
“For the first time, we have provided a summary of all published studies of any dietary factor associated with all-cause mortality in individuals with type 2 diabetes,” Barbarescu said. Furthermore, the certainty of the evidence was assessed for the first time.
The session was moderated by Matthias Schulze, MD, Head of the German Institute of Human Nutrition, Nuthtal, Germany.
He noted that the new work “summarizes the available evidence, and provides important nutritional advice for people with diabetes, for example, recommending whole grains.”
“However, the study also points to gaps in knowledge, so for many factors of diet we have either no or few studies, or study quality is considered low, which requires further research to fill the gap.”
Eating high versus low amounts of different nutritional factors
The researchers performed meta-analyses based on published studies of all-cause mortality in individuals with type 2 diabetes aged 18 years or older, as related to dietary patterns, macronutrients (carbohydrates, protein, and fats), micronutrients (vitamins and minerals) and secondary plants. compounds (for example, polyphenols); and nutritional supplements.
The studies were conducted mainly in the United States and Europe with an average follow-up of 10 years. Low and high intakes were compared, and the dose-response relationship between different dietary factors and all-cause mortality was explored to generate summary risk ratios (SRRs). The researchers also explored how the certainty of the evidence was determined.
Low mortality from any cause was found for higher fish intake (Energy intake per serving/week: 0.95, over six studies); whole grains (SRR per 20 g/day: 0.84; 2 studies); Fiber (SRR per 5 g/day: 0.86; three studies), and omega-3 polyunsaturated fatty acids (SRR per 0.1 g/day: 0.87; two studies).
Low certainty of evidence for an inverse association was found between all-cause mortality and vegetable consumption (SRR per 100 g/day: 0.88; two studies) and vegetable protein intake (SRR per 10 g/day: 0.91; three studies).
Eggs were associated with an increased risk of all-cause mortality (mortality rate per 10 g/day: 1.05; seven studies), as well as dietary cholesterol (SRR per 300 mg/day: 1.19; two studies).
Regarding other dietary patterns, including the Mediterranean diet and the low-carbohydrate diet, either no association was found and/or the evidence was very uncertain. Similarly, the evidence was anecdotal for foods including nuts, dairy products, meat, sugar and sweets. macronutrient intake, including carbohydrates; and micronutrients, such as caffeine and vitamin D.
“With the Mediterranean diet, we saw an inverse association [with all-cause mortality] comparing high adherence to low adherence to the Mediterranean diet, but the ascertainment of the evidence was very low, suggesting really uncertain evidence.”
It concluded that a larger number of studies are needed to investigate the association of dietary factors with all causes of mortality in type 2 diabetes to strengthen the evidence for many other dietary factors. She also cautioned that meta-analyses are affected by unmeasured and residual confusion.
Barbaresco and Schulze You have not reported any relevant financial relationships.
EASD Annual Meeting 2022. Abstract 01. Filed September 20, 2022.