Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
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Tables
- Table 1
Descriptive statistics of studies included in the meta-analysis
Intervention period (weeks) Dropout (%) LFHC HFLC Age (years) Men (%) BMI Using antihyperglycemia agents (%) Diabetes duration (years) n C/F/P (%) n C/F/P (%) Campbell et al. (1994; ref. 13) 2 N/A 10 55/22/23 10 40/37/23 55 100 26.5 10 5 Chen et al. (1995; ref. 14) 6 N/A 9 55/30/15 9 40/45/15 49 67 27.5 N/A N/A Coulston et al. (1989; ref. 15) 6 0 8 60/20/20 8 40/40/20 66 63 25.5 75 N/A Fuh et al. (1990; ref. 16) 2 N/A 11 60/20/20 11 40/40/20 58 100 25.8 100 N/A Garg et al. (1992; ref. 17) 3 N/A 8 60/25/15 8 35/50/15 63 100 30 0 N/A Garg et al. (1994; ref. 18) 6 0 42 55/30/15 42 40/45/15 58 79 28.1 100 N/A Heilbronn et al. (1999a; ref. 19) 12 17 12 73/10/17 10 50/32/18 58 27 32.9 58 5 Heilbronn et al. (1999b; ref. 19) 12 15 12 73/10/17 13 50/32/18 58 20 33.1 52 6 Lovejoy et al. (2002a; ref. 20) 4 12 30 58/27/15 30 46/39/15 54 43 33 47 N/A Lovejoy et al. (2002b; ref. 20) 4 12 30 58/27/15 30 46/39/15 54 43 33 47 N/A Luscombe et al. (1999; ref. 21) 4 25 21 53/21/26 21 42/35/23 57 67 30.4 76 6 Miyashita et al. (2004; ref. 22) 4 N/A 11 63/10/27 11 40/35/25 52 73 27 0 N/A Parillo et al. (1992; ref. 23) 2 0 10 60/20/20 10 40/40/20 53 70 26.7 50 8 Parillo et al. (1996a; ref. 24) 2 0 9 60/20/20 9 40/40/20 48 N/A 24.7 0 6 Parillo et al. (1996b; ref. 24) 2 0 9 60/20/20 9 40/40/20 50 N/A 24.6 100 8 Rodriguez-Villar et al. (2000; ref. 25) 6 25 12 55/30/15 12 45/40/15 N/A N/A 27.9 N/A 6 Rodriguez-Villar et al. (2004; ref. 26) 6 15 22 55/30/15 22 45/40/15 61 54 28.3 N/A N/A Rusmussen et al. (1994; refs. 27, 28) 3 N/A 15 50/30/20 15 30/50/20 57 67 27 47 6 Sestoft et al. (1985; ref. 29) 1.4 N/A 8 50/30/20 8 42/36/22 48 50 22.7 0 5 Simpson et al. (1982; ref. 30) 4 N/A 10 60/22/18 10 35/47/18 58 N/A 26.2 80 6 Storm et al. (1997a; ref. 31) 3 0 15 50/30/20 15 40/45/15 53 53 29.7 73 6 Storm et al. (1997b; ref. 31) 3 0 15 50/30/20 15 40/45/15 53 53 29.7 73 6 Median 4 6 12 58/24/20 12 40/40/20 55 65 27.7 52 6 Minimum 1.4 0 8 8 48 20 22.7 0 5 Maximum 12 25 42 42 66 100 33.1 100 8 -
C/F/P, proportion of carbohydrate/fat/protein to total energy of the prescribed diet; N/A, not assessed.
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- Table 2
Overall percent changes resulting from LFHC versus HFLC diet on metabolic profiles and data on publication bias and their likely effect on the estimates
A1C FPG 2-h glucose Fasting insulin 2-h fasting insulin Total cholesterol Triglycerides HDL cholesterol LDL cholesterol Trials (n) 10 22 10 22 9 20 22 20 16 Overall percent change −1.5 0.3 10.3 8.4 12.8 1.6 13.4 −5.6 0.1 95% CI −5.3 to 2.3 −2.8 to 3.4 6.7–13.9 1.3–15.6 5.2–20.4 −1.3 to 4.5 7.1–19.8 −8.4 to −2.9 −3.8 to 4.1 P 0.70 0.87 <0.001 0.02 <0.001 0.27 <0.001 <0.001 0.94 Publication bias Begg's 0.80 0.82 0.25 0.30 0.40 0.85 0.48 0.75 0.86 Egger's 0.47 0.30 0.12 0.13 0.16 0.26 0.75 0.08 0.92 Trim and fill Fill* 7 Adjusted† −7.6 95% CI −10.2 to −5.0 - Table 3
Stratified analysis to examine the effects of characteristics of studies and patients on each metabolic profile
FPG Fasting insulin Triglycerides Total cholesterol HDL cholesterol LDL cholesterol N Percent change (95% CI) N Percent change (95% CI) N Percent change (95% CI) N Percent change (95% CI) N Percent change (95% CI) N Percent change (95% CI) Study with washout period or baseline data Neither* 10 0.9 (−4.6 to 6.3) 10 9.0 (−1.7 to 19.7) 10 18.2 (7.3–29.1) 9 0.7 (−4.2 to 5.5) 9 −6.8 (−10.3 to −3.2) 5 −0.7 (−8 to 6.6) Others† 12 0.0 (−3.8 to 3.7) 12 8.0 (−1.6 to 17.6) 11.0 (3.2–18.8) 11 2.2 (−1.5 to 5.8) 11 −4.0 (−8.2 to 0.3) 11 0.5 (−4.2 to 5.1) Period <4 weeks 10 1.3 (−2.9 to 5.5) 10 15.2 (3.1–27.3) 10 15.8 (4.9–26.6) 10 1.7 (−3 to 6.4) 10 −7.3 (−10.9 to −3.6) 6 0.8 (−7.5 to 9.1) Period ≥4 weeks 12 −1 (−5.5 to 3.6) 12 4.9 (−3.9 to 13.7) 12 12.2 (4.4–20) 10 1.6 (−2.1 to 5.3) 10 −3.6 (−7.7 to 0.6) 10 0.0 (−4.5 to 4.4) <50% of subjects female 13 0.4 (−3.3 to 4.1) 13 6.2 (−3.4 to 15.9) 13 13.7 (5.8–21.6) 11 2 (−1.8 to 5.9) 11 −3.4 (−8.1 to 1.2) 10 0.6 (−4.6 to 5.8) ≥50% of subjects female 5 1.6 (−4.6 to 7.8) 5 11.5 (−0.1 to 23.2) 5 15.1 (2.8–27.3) 5 1.8 (−3.8 to 7.4) 5 −7.4 (−11 to −3.7) 4 −0.5 (−7 to 6.1) Mean age <55 years 10 −0.2 (−4.1 to 3.7) 10 17.2 (6.7–27.8)‡ 10 12.7 (4.6–20.8) 8 1.2 (−3.9 to 6.2) 8 −5.8 (−9.2 to −2.4) 4 −0.6 (−7.5 to 6.3) Mean age ≥55 years 11 1.2 (−3.9 to 6.4) 11 1.7 (−8.2 to 11.7)‡ 11 15.1 (4.5–25.7) 11 1.9 (−1.7 to 5.5) 11 −5.6 (−10.3 to −0.8) 11 0.7 (−4.2 to 5.5) BMI <28.0 kg/m2 12 1.9 (−2.8 to 6.6) 12 18.2 (7.6–28.8)‡ 12 12.5 (4.6–20.4) 10 1.2 (−3.5 to 5.8) 10 −7.8 (−11.6 to −4.1) 6 −0.9 (−8.6 to 6.9) BMI ≥28.0 kg/m2 10 −1 (−5.1 to 3.1) 10 0.3 (−9.4 to 9.9)‡ 10 15.1 (4.6–25.7) 10 1.9 (−1.8 to 5.6) 10 −3.1 (−7.1 to 0.9) 10 0.5 (−4.1 to 5) Taking hypoglycemic agents 18 −0.6 (−4.1 to 2.9) 18 4.4 (−3.8 to 12.7)§ 18 15.4 (6.9–23.8) 17 1.5 (−1.5 to 4.6) 17 −3.1 (−6.6 to 0.4) 15 0.1 (−3.8 to 4.1) Not taking hypoglycemic agents 4 2.9 (−3.3 to 9.1) 4 20.7 (6.3–35.1)§ 4 10.9 (1.4–20.5) 3 2.6 (−6.7 to 11.8) 3 −9.4 (−13.7 to −5.1) 1 0 (−31.8 to 31.8) C/F ratio in LFHC ≥3 8 0.5 (−5.5 to 6.5) 8 17.1 (5.7–28.6)§ 8 9.3 (−0.9 to 19.4) 7 −0.1 (−5.4 to 5.1) 7 −4.6 (−10.9 to 1.6) 4 −3.1 (−11.4 to 5.2) C/F ratio in LFHC <3 14 0.2 (−3.4 to 3.8) 14 2.9 (−6.2 to 12.1)§ 14 16 (8–24.1) 13 2.4 (−1.1 to 5.9) 13 −5.9 (−8.9 to −2.8) 12 1.1 (−3.4 to 5.5) C/F ratio in HFLC ≤1 12 0.2 (−3.8 to 4.2) 12 8.1 (−4 to 20.2) 12 18.7 (8.3–29.1) 11 1.2 (−2.7 to 5) 11 −4.2 (−9.1 to 0.6) 8 −0.6 (−6.4 to 5.2) C/F ratio in HFLC >1 10 0.4 (−4.5 to 5.2) 10 8.6 (−0.2 to 17.5) 10 10.4 (2.4–18.3) 9 2.2 (−2.2 to 6.6) 9 −6.3 (−9.6 to −3) 8 0.8 (−4.5 to 6.1) MUFA diet in HFLC diet 11 1.9 (−3.9 to 7.7) 11 5.2 (−4.9 to 15.2) 11 21.0 (10.2–31.7)§ 10 3.1 (−1.1 to 7.2) 10 −4.3 (−9.4 to 0.8) 7 2.8 (−3.4 to 8.9) No MUFA diet in HFLC diet 11 −0.4 (−4.0 to 3.3) 11 11.8 (1.7–22) 11 9.4 (1.6–17.2)§ 10 0.2 (−3.8 to 4.3) 10 −6.2 (−9.4 to −3) 9 −1.6 (−6.7 to 3.4) WL diet in LFHC and HFLC diets 4 −2.1 (−9.6 to 5.5) 4 12.5 (−1 to 25.9) 4 4.0 (−7.1 to 15.2)‡ 3 1.3 (−6 to 8.5) 3 −3.9 (−12.4 to 4.6) 3 1.9 (−7.4 to 11.2) No WL diet in LFHC and HFLC diets 18 0.7 (−2.7 to 4.1) 18 6.9 (−1.5 to 15.3) 18 17.9 (10.2–25.5)‡ 17 1.7 (−1.5 to 4.9) 17 −5.8 (−8.7 to −3) 13 −0.2 (−4.6 to 4.1)
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