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Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis

  1. Satoru Kodama, MD, PHD1,
  2. Kazumi Saito, MD, PHD1,
  3. Shiro Tanaka, PHD2,
  4. Miho Maki, MS1,
  5. Yoko Yachi, RD1,
  6. Mutsumi Sato, RD1,
  7. Ayumi Sugawara, RD1,
  8. Kumiko Totsuka, RD1,
  9. Hitoshi Shimano, MD, PHD3,
  10. Yasuo Ohashi, PHD2,
  11. Nobuhiro Yamada, MD, PHD3 and
  12. Hirohito Sone, MD, PHD, FACP1
  1. 1Department of Lifestyle Medicine and Applied Nutrition, Ochanomizu University, Tokyo, Japan;
  2. 2Department of Biostatistic, Epidemiology and Preventive Health Sciences, University of Tokyo, Tokyo, Japan;
  3. 3Endocrinology and Metabolism, University of Tsukuba, Tsukuba, Japan.
  1. Corresponding author: Hirohito Sone, sone.hirohito{at}ocha.ac.jp
Diabetes Care 2009 May; 32(5): 959-965. https://doi.org/10.2337/dc08-1716
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Article Figures & Tables

Tables

  • Table 1

    Descriptive statistics of studies included in the meta-analysis

    Intervention period (weeks)Dropout (%)LFHC
    HFLC
    Age (years)Men (%)BMIUsing antihyperglycemia agents (%)Diabetes duration (years)
    nC/F/P (%)nC/F/P (%)
    Campbell et al. (1994; ref. 13)2N/A1055/22/231040/37/235510026.5105
    Chen et al. (1995; ref. 14)6N/A955/30/15940/45/15496727.5N/AN/A
    Coulston et al. (1989; ref. 15)60860/20/20840/40/20666325.575N/A
    Fuh et al. (1990; ref. 16)2N/A1160/20/201140/40/205810025.8100N/A
    Garg et al. (1992; ref. 17)3N/A860/25/15835/50/1563100300N/A
    Garg et al. (1994; ref. 18)604255/30/154240/45/15587928.1100N/A
    Heilbronn et al. (1999a; ref. 19)12171273/10/171050/32/18582732.9585
    Heilbronn et al. (1999b; ref. 19)12151273/10/171350/32/18582033.1526
    Lovejoy et al. (2002a; ref. 20)4123058/27/153046/39/1554433347N/A
    Lovejoy et al. (2002b; ref. 20)4123058/27/153046/39/1554433347N/A
    Luscombe et al. (1999; ref. 21)4252153/21/262142/35/23576730.4766
    Miyashita et al. (2004; ref. 22)4N/A1163/10/271140/35/255273270N/A
    Parillo et al. (1992; ref. 23)201060/20/201040/40/20537026.7508
    Parillo et al. (1996a; ref. 24)20960/20/20940/40/2048N/A24.706
    Parillo et al. (1996b; ref. 24)20960/20/20940/40/2050N/A24.61008
    Rodriguez-Villar et al. (2000; ref. 25)6251255/30/151245/40/15N/AN/A27.9N/A6
    Rodriguez-Villar et al. (2004; ref. 26)6152255/30/152245/40/15615428.3N/AN/A
    Rusmussen et al. (1994; refs. 27, 28)3N/A1550/30/201530/50/20576727476
    Sestoft et al. (1985; ref. 29)1.4N/A850/30/20842/36/22485022.705
    Simpson et al. (1982; ref. 30)4N/A1060/22/181035/47/1858N/A26.2806
    Storm et al. (1997a; ref. 31)301550/30/201540/45/15535329.7736
    Storm et al. (1997b; ref. 31)301550/30/201540/45/15535329.7736
    Median461258/24/201240/40/20556527.7526
    Minimum1.4088482022.705
    Maximum122542426610033.11008
    • C/F/P, proportion of carbohydrate/fat/protein to total energy of the prescribed diet; N/A, not assessed.

  • 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

    A1CFPG2-h glucoseFasting insulin2-h fasting insulinTotal cholesterolTriglyceridesHDL cholesterolLDL cholesterol
    Trials (n)10221022920222016
    Overall percent change−1.50.310.38.412.81.613.4−5.60.1
        95% CI−5.3 to 2.3−2.8 to 3.46.7–13.91.3–15.65.2–20.4−1.3 to 4.57.1–19.8−8.4 to −2.9−3.8 to 4.1
        P0.700.87<0.0010.02<0.0010.27<0.001<0.0010.94
    Publication bias
        Begg's0.800.820.250.300.400.850.480.750.86
        Egger's0.470.300.120.130.160.260.750.080.92
    Trim and fill
        Fill*7
        Adjusted†−7.6
        95% CI−10.2 to −5.0
    • ↵*Studies (n) added by the trim-and-fill method.

    • ↵†Percent change after adjustment for publication bias by the trim-and-fill method. Begg's, Begg's adjusted rank correlation test; Egger's, Egger's regression asymmetry test.

  • 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
    NPercent change (95% CI)NPercent change (95% CI)NPercent change (95% CI)NPercent change (95% CI)NPercent change (95% CI)NPercent change (95% CI)
    Study with washout period or baseline data
        Neither*100.9 (−4.6 to 6.3)109.0 (−1.7 to 19.7)1018.2 (7.3–29.1)90.7 (−4.2 to 5.5)9−6.8 (−10.3 to −3.2)5−0.7 (−8 to 6.6)
        Others†120.0 (−3.8 to 3.7)128.0 (−1.6 to 17.6)11.0 (3.2–18.8)112.2 (−1.5 to 5.8)11−4.0 (−8.2 to 0.3)110.5 (−4.2 to 5.1)
    Period <4 weeks101.3 (−2.9 to 5.5)1015.2 (3.1–27.3)1015.8 (4.9–26.6)101.7 (−3 to 6.4)10−7.3 (−10.9 to −3.6)60.8 (−7.5 to 9.1)
    Period ≥4 weeks12−1 (−5.5 to 3.6)124.9 (−3.9 to 13.7)1212.2 (4.4–20)101.6 (−2.1 to 5.3)10−3.6 (−7.7 to 0.6)100.0 (−4.5 to 4.4)
    <50% of subjects female130.4 (−3.3 to 4.1)136.2 (−3.4 to 15.9)1313.7 (5.8–21.6)112 (−1.8 to 5.9)11−3.4 (−8.1 to 1.2)100.6 (−4.6 to 5.8)
    ≥50% of subjects female51.6 (−4.6 to 7.8)511.5 (−0.1 to 23.2)515.1 (2.8–27.3)51.8 (−3.8 to 7.4)5−7.4 (−11 to −3.7)4−0.5 (−7 to 6.1)
    Mean age <55 years10−0.2 (−4.1 to 3.7)1017.2 (6.7–27.8)‡1012.7 (4.6–20.8)81.2 (−3.9 to 6.2)8−5.8 (−9.2 to −2.4)4−0.6 (−7.5 to 6.3)
    Mean age ≥55 years111.2 (−3.9 to 6.4)111.7 (−8.2 to 11.7)‡1115.1 (4.5–25.7)111.9 (−1.7 to 5.5)11−5.6 (−10.3 to −0.8)110.7 (−4.2 to 5.5)
    BMI <28.0 kg/m2121.9 (−2.8 to 6.6)1218.2 (7.6–28.8)‡1212.5 (4.6–20.4)101.2 (−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/m210−1 (−5.1 to 3.1)100.3 (−9.4 to 9.9)‡1015.1 (4.6–25.7)101.9 (−1.8 to 5.6)10−3.1 (−7.1 to 0.9)100.5 (−4.1 to 5)
    Taking hypoglycemic agents18−0.6 (−4.1 to 2.9)184.4 (−3.8 to 12.7)§1815.4 (6.9–23.8)171.5 (−1.5 to 4.6)17−3.1 (−6.6 to 0.4)150.1 (−3.8 to 4.1)
    Not taking hypoglycemic agents42.9 (−3.3 to 9.1)420.7 (6.3–35.1)§410.9 (1.4–20.5)32.6 (−6.7 to 11.8)3−9.4 (−13.7 to −5.1)10 (−31.8 to 31.8)
    C/F ratio in LFHC ≥380.5 (−5.5 to 6.5)817.1 (5.7–28.6)§89.3 (−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 <3140.2 (−3.4 to 3.8)142.9 (−6.2 to 12.1)§1416 (8–24.1)132.4 (−1.1 to 5.9)13−5.9 (−8.9 to −2.8)121.1 (−3.4 to 5.5)
    C/F ratio in HFLC ≤1120.2 (−3.8 to 4.2)128.1 (−4 to 20.2)1218.7 (8.3–29.1)111.2 (−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 >1100.4 (−4.5 to 5.2)108.6 (−0.2 to 17.5)1010.4 (2.4–18.3)92.2 (−2.2 to 6.6)9−6.3 (−9.6 to −3)80.8 (−4.5 to 6.1)
    MUFA diet in HFLC diet111.9 (−3.9 to 7.7)115.2 (−4.9 to 15.2)1121.0 (10.2–31.7)§103.1 (−1.1 to 7.2)10−4.3 (−9.4 to 0.8)72.8 (−3.4 to 8.9)
    No MUFA diet in HFLC diet11−0.4 (−4.0 to 3.3)1111.8 (1.7–22)119.4 (1.6–17.2)§100.2 (−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 diets4−2.1 (−9.6 to 5.5)412.5 (−1 to 25.9)44.0 (−7.1 to 15.2)‡31.3 (−6 to 8.5)3−3.9 (−12.4 to 4.6)31.9 (−7.4 to 11.2)
    No WL diet in LFHC and HFLC diets180.7 (−2.7 to 4.1)186.9 (−1.5 to 15.3)1817.9 (10.2–25.5)‡171.7 (−1.5 to 4.9)17−5.8 (−8.7 to −3)13−0.2 (−4.6 to 4.1)
    • ↵*Studies having neither a washout period nor baseline data.

    • ↵†Parallel study design or cross-sectional design studies that have a washout period and/or baseline data.

    • ↵‡P < 0.01;

    • ↵§P < 0.05. WL diet, energy intake restricted for weight loss.

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Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
Satoru Kodama, Kazumi Saito, Shiro Tanaka, Miho Maki, Yoko Yachi, Mutsumi Sato, Ayumi Sugawara, Kumiko Totsuka, Hitoshi Shimano, Yasuo Ohashi, Nobuhiro Yamada, Hirohito Sone
Diabetes Care May 2009, 32 (5) 959-965; DOI: 10.2337/dc08-1716

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Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
Satoru Kodama, Kazumi Saito, Shiro Tanaka, Miho Maki, Yoko Yachi, Mutsumi Sato, Ayumi Sugawara, Kumiko Totsuka, Hitoshi Shimano, Yasuo Ohashi, Nobuhiro Yamada, Hirohito Sone
Diabetes Care May 2009, 32 (5) 959-965; DOI: 10.2337/dc08-1716
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