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Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials.

Viguiliouk E, Kendall CW, Blanco Mejia S, Cozma AI, Ha V, Mirrahimi A, Jayalath VH, Augustin LS, Chiavaroli L, Leiter LA, de Souza RJ, Jenkins DJ, Sievenpiper JL - PLoS ONE (2014)

Bottom Line: Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI's.Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2).No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.

View Article: PubMed Central - PubMed

Affiliation: Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT

Background: Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent.

Objective: To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes.

Data sources: MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014.

Study selection: Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR.

Data extraction and synthesis: Two independent reviewer's extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI's. Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2).

Results: Twelve trials (n = 450) were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = -0.07% [95% CI:-0.10, -0.03%]; P = 0.0003) and fasting glucose (MD = -0.15 mmol/L [95% CI: -0.27, -0.02 mmol/L]; P = 0.03) compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.

Limitations: Majority of trials were of short duration and poor quality.

Conclusions: Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates.

Trial registration: ClinicalTrials.gov NCT01630980.

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Related in: MedlinePlus

Publication bias funnel plots.Publication bias funnel plots for HbA1c (A), fasting glucose (B), fasting insulin (C), and HOMA-IR (D). The solid line represents the pooled effect estimate expressed as the weighted mean difference for each analysis. The dashed lines represent pseudo-95% confidence limits. P-values displayed in the top right corner of each funnel plot are derived from quantitative assessment of publication bias by Egger’s and Begg’s tests.
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pone-0103376-g006: Publication bias funnel plots.Publication bias funnel plots for HbA1c (A), fasting glucose (B), fasting insulin (C), and HOMA-IR (D). The solid line represents the pooled effect estimate expressed as the weighted mean difference for each analysis. The dashed lines represent pseudo-95% confidence limits. P-values displayed in the top right corner of each funnel plot are derived from quantitative assessment of publication bias by Egger’s and Begg’s tests.

Mentions: Figure 6 (A–D) shows the funnel plots for each glycemic endpoint. Visual inspection of funnel plots revealed asymmetry for fasting insulin, suggesting study effects favouring the tree nut intervention. Egger’s and Begg’s tests did not reveal significant evidence of publication bias for any of the primary analyses. With one exception, these tests should be interpreted with caution, as they were based on <10 trials.


Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials.

Viguiliouk E, Kendall CW, Blanco Mejia S, Cozma AI, Ha V, Mirrahimi A, Jayalath VH, Augustin LS, Chiavaroli L, Leiter LA, de Souza RJ, Jenkins DJ, Sievenpiper JL - PLoS ONE (2014)

Publication bias funnel plots.Publication bias funnel plots for HbA1c (A), fasting glucose (B), fasting insulin (C), and HOMA-IR (D). The solid line represents the pooled effect estimate expressed as the weighted mean difference for each analysis. The dashed lines represent pseudo-95% confidence limits. P-values displayed in the top right corner of each funnel plot are derived from quantitative assessment of publication bias by Egger’s and Begg’s tests.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4116170&req=5

pone-0103376-g006: Publication bias funnel plots.Publication bias funnel plots for HbA1c (A), fasting glucose (B), fasting insulin (C), and HOMA-IR (D). The solid line represents the pooled effect estimate expressed as the weighted mean difference for each analysis. The dashed lines represent pseudo-95% confidence limits. P-values displayed in the top right corner of each funnel plot are derived from quantitative assessment of publication bias by Egger’s and Begg’s tests.
Mentions: Figure 6 (A–D) shows the funnel plots for each glycemic endpoint. Visual inspection of funnel plots revealed asymmetry for fasting insulin, suggesting study effects favouring the tree nut intervention. Egger’s and Begg’s tests did not reveal significant evidence of publication bias for any of the primary analyses. With one exception, these tests should be interpreted with caution, as they were based on <10 trials.

Bottom Line: Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI's.Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2).No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.

View Article: PubMed Central - PubMed

Affiliation: Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT

Background: Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent.

Objective: To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes.

Data sources: MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014.

Study selection: Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR.

Data extraction and synthesis: Two independent reviewer's extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI's. Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2).

Results: Twelve trials (n = 450) were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = -0.07% [95% CI:-0.10, -0.03%]; P = 0.0003) and fasting glucose (MD = -0.15 mmol/L [95% CI: -0.27, -0.02 mmol/L]; P = 0.03) compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.

Limitations: Majority of trials were of short duration and poor quality.

Conclusions: Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates.

Trial registration: ClinicalTrials.gov NCT01630980.

Show MeSH
Related in: MedlinePlus