低脂饮食与低碳饮食对2型糖尿病患者心血管指标的影响:随机对照试验的系统性评价和Meta分析

目的 对比低碳饮食和低脂饮食干预2型糖尿病患者后对心血管指标的影响。方法 通过检索PubMed、EMbase、Cochrane Library、万方医学网、CNKI等数据库,至2020年10月发表的2型糖尿病患者用低碳饮食（碳水供能＜40%）和低脂饮食（脂肪供能≤30%）干预12个月以上的随机对照试验,用Review Manager 5.3软件进行meta分析。结果 共纳入文献5篇,2型糖尿病患者450例。meta分析显示,与低脂饮食相比,低碳饮食对高密度脂蛋白升高的效果有统计学差异（MD = 0.32,95%CI:0.14～0.51,P＜0.05）。在体重（MD = - 0.42,95%CI:- 0.91～0.07, P = 0.09）、糖化血红蛋白（MD = - 0.08,95%CI:- 0.26～0.11,P = 0.43）、收缩压（MD = - 1.52,95%CI:- 5.66～2.61,P = 0.47）、舒张压（MD = 0.02,95%CI:- 0.24～0.29,P = 0.86）、低密度脂蛋白（MD = 0.02,95%CI:- 0.18～0.21,P = 0.87）、总胆固醇（MD = 0.17,95%CI:- 0.02～0.35,P = 0.08）和甘油三酯（MD = - 0.437,95%CI:- 1.08～0.14,P = 0.13）等指标的对比中,未显示出统计学差异。结论 对2型糖尿病患者干预12个月以上,低碳饮食和低脂饮食对改善心血管指标的效果未见差异。     

Omega-3 polyunsaturated fatty acid and insulin sensitivity: a meta-analysis of randomized controlled trials

Background &aim

n-3 PUFA has been shown to decrease the risk of several components of the metabolic syndrome; however, the role of n-3 PUFA on glucose metabolism is not clear. Our aim was to systematically review the effect of n-3 PUFA on IS by conducting a meta-analysis of available RCTs.

Methods

We followed the guidelines of Cochrane’s review of systematic interventions. We searched MEDLINE, EMBASE, CENTRAL and clinicaltrials.gov from the beginning of each database until October 2010. Meta-analysis was performed using a random effects model to estimate a pooled SMD and the corresponding 95% CI.

Results

From 303 screened citations, 11 RCTs (n = 618) were eligible for inclusion in the analysis. In a pooled estimate, n-3 PUFA intervention had no effects on IS compared to placebo (SMD 0.08, 95% CI −0.11–0.28). Similarly, n-3 PUFA had no effects on IS in sub-group analyses (Type 2 diabetes vs. other population; QUICKI and other test subgroups). In the HOMA subgroup, n-3 PUFA was associated with a statistically significant increase in IS (SMD 0.30, CI 0.03–0.58) when compared to placebo.

Conclusion

This meta-analysis is consistent with a lack of n-3 PUFA effects on IS.     

Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials

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不同胰岛β细胞功能指数对评价2型糖尿病糖代谢的作用

目的 探讨不同胰岛β细胞功能指数评价不同病程2型糖尿病(T2DM)患者糖代谢的作用.方法 选取无糖尿病家族史的糖耐量正常者48例(对照组)和T2DM患者182例,T2DM患者根据病程不同分为＜5年组(DM＜5组)74例、5～10年组(DM5 ～10组)51例和＞10年组(DM＞10组)57例.行口服葡萄糖耐量试验(OGTT)和胰岛素释放试验,以稳态模型评估的胰岛素抵抗指数(HOMA-IR)和全身胰岛素敏感指数[ISI(Matsuda)]评估胰岛素敏感性；以早期胰岛素分泌功能指数(△I30/△G30)和葡萄糖处置指数(DI)评估胰岛β细胞功能.结果 DM＜5组、DM5～10组和DM＞10组HOMA-IR较对照组升高(8.78±7.12、8.08±3.67、7.84±5.08比4.76±3.43,P＜ 0.05),ISI(Matsuda)较对照组降低(46.78±29.00、36.71±16.67、38.86±21.72比61.13±32.08,P＜0.05),DM＜5组、DM5～10组和DM＞10组比较差异无统计学意义(P＞0.05).DM＜5组、DM5～10组和DM＞10组△I30/△G30和DI均较对照组降低[△I30/△G30:(68.41±361.52)、(4.31±3.42)、(7.70±5.78) mU/mmol比(92.65±309.29)mU/mmol; DI:0.0421±0.0123、0.0412±0.0123、0.0363±0.0116比0.1151±0.0236,P＜ 0.05]. DM＜5组、DM5-10组和DM＞10组△I30/△G30比较差异无统计学意义(P＞0.05)；与DM＜5组和DM5～10组比较,DM＞10组DI显著降低(P＜0.05).结论 HOMA-IR、ISI(Matsuda)、△I30/△G30对评价不同病程胰岛素抵抗程度敏感性不高；DI能更早地反映胰岛β细胞对葡萄糖的利用,调节血糖稳态能力的变化.     

Smoking and the risk of type 2 diabetes in Japan: A systematic review and meta-analysis

Cigarette smoking is the leading avoidable cause of disease burden. Observational studies have suggested an association between smoking and risk of type 2 diabetes mellitus (T2DM). We conducted a meta-analysis of prospective observational studies to investigate the association of smoking status, smoking intensity, and smoking cessation with the risk of T2DM in Japan, where the prevalence of smoking has been decreasing but remains high. We systematically searched MEDLINE and the Ichushi database to December 2015 and identified 22 eligible articles, representing 343,573 subjects and 16,383 patients with T2DM. We estimated pooled relative risks (RRs) using a random-effects model and conducted subgroup analyses by participant and study characteristics. Compared with nonsmoking, the pooled RR of T2DM was 1.38 (95% confidence interval [CI], 1.28–1.49) for current smoking (19 studies) and 1.19 (95% CI, 1.09–1.31) for former smoking (15 studies). These associations persisted in all subgroup and sensitivity analyses. We found a linear dose-response relationship between cigarette consumption and T2DM risk; the risk of T2DM increased by 16% for each increment of 10 cigarettes smoked per day. The risk of T2DM remained high among those who quit during the preceding 5 years but decreased steadily with increasing duration of cessation, reaching a risk level comparable to that of never smokers after 10 years of smoking cessation. We estimated that 18.8% of T2DM cases in men and 5.4% of T2DM cases in women were attributable to smoking. The present findings suggest that cigarette smoking is associated with an increased risk of T2DM, so tobacco control programs to reduce smoking could have a substantial effect to decrease the burden of T2DM in Japan.