Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials

Summary Background & aims To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of randomized controlled trials to summarize the evidence for the effect of vegetarian dietary patterns on glycemic control and other established cardiometabolic risk factors in individuals with diabetes. Methods We searched MEDLINE, EMBASE, and Cochrane databases through February 26, 2018 for randomized controlled trials ≥3 weeks assessing the effect of vegetarian dietary patterns in individuals with diabetes. The primary outcome was HbA 1c . Secondary outcomes included other markers of glycemic control, blood lipids, body weight/adiposity, and blood pressure. Two independent reviewers extracted data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results Nine trials (n = 664 participants) met the eligibility criteria. Vegetarian dietary patterns significantly lowered HbA 1c (MD = −0.29% [95% CI: −0.45, −0.12%]), fasting glucose (MD = −0.56 mmol/L [95% CI: −0.99, −0.13 mmol/L]), LDL-C (MD = −0.12 mmol/L [95% CI: −0.20, −0.04 mmol/L]), non-HDL-C (MD = −0.13 mmol/L [95% CI: −0.26, −0.01 mmol/L]), body weight (MD = −2.15 kg [95% CI: −2.95, −1.34 kg]), BMI (MD = −0.74 kg/m 2 [95% CI: −1.09, −0.39 kg/m 2 ]) and waist circumference (MD = −2.86 cm [95% CI: −3.76, −1.96 cm]). There was no significant effect on fasting insulin, HDL-C, triglycerides or blood pressure. The overall certainty of evidence was moderate but was low for fasting insulin, triglycerides and waist circumference. Conclusion Vegetarian dietary patterns improve glycemic control, LDL-C, non-HDL-C, and body weight/adiposity in individuals with diabetes, supporting their inclusion for diabetes management. More research is needed to improve our confidence in the estimates. ClinicalTrials.gov identifier NCT02600377 .