Vitamins C, E, and β-Carotene and Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis

IF 8 1区医学 Q1 NUTRITION & DIETETICS

Advances in Nutrition Pub Date : 2024-03-15 DOI:10.1016/j.advnut.2024.100211

Anna-Maria Lampousi , Therese Lundberg , Josefin E Löfvenborg , Sofia Carlsson

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Abstract

A systematic review and meta-analysis was conducted to assess the relationship between the common dietary antioxidants vitamin C, vitamin E, and β-carotene and type 2 diabetes (T2D) and related traits. MEDLINE, Embase, and the Cochrane Library were searched for relevant publications up until May 2023. Studies were eligible if they had a cohort, case–control, or randomized controlled trial (RCT) design and examined dietary intake, supplementation, or circulating levels of these antioxidants as exposure, and insulin resistance, β-cell function, or T2D incidence as outcomes. Summary relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI) were estimated using random-effects models. The certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluations framework. Among 6190 screened records, 25 prospective observational studies and 15 RCTs were eligible. Inverse associations were found between dietary and circulating antioxidants and T2D (observational studies). The lowest risk was seen at intakes of 70 mg/d of vitamin C (RR: 0.76; CI: 0.61, 0.95), 12 mg/d of vitamin E (RR: 0.72; CI: 0.61, 0.86), and 4 mg/d of β-carotene (RR: 0.78; CI: 0.65, 0.94). Supplementation with vitamin E (RR: 1.01; CI: 0.93, 1.10) or β-carotene (RR: 0.98; CI: 0.90, 1.07) did not have a protective effect on T2D (RCTs), and data on vitamin C supplementation was limited. Regarding insulin resistance, higher dietary vitamin C (RR: 0.85; CI: 0.74, 0.98) and vitamin E supplementation (MD: –0.35; CI: –0.65, –0.06) were associated with a reduced risk. The certainty of evidence was high for the associations between T2D and dietary vitamin E and β-carotene, and low to moderate for other associations. In conclusion, moderate intakes of vitamins C, E, and β-carotene may lower risk of T2D by reducing insulin resistance. Lack of protection with supplementation in RCTs suggests that adequate rather than high intakes may play a role in T2D prevention. This systematic review and meta-analysis was registered in PROSPERO with registration number CRD42022343482.

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维生素 C、E 和 β-胡萝卜素与 2 型糖尿病风险：系统回顾和荟萃分析。

一项系统综述和荟萃分析旨在评估常见膳食抗氧化剂维生素 C、E 和 β-胡萝卜素与 2 型糖尿病（T2D）及相关特征之间的关系。在 MEDLINE、Embase 和 Cochrane 图书馆中检索了截至 2023 年 5 月的相关出版物。凡采用队列、病例对照或随机对照试验（RCT）设计，以膳食摄入量、补充剂或这些抗氧化剂的循环水平作为暴露量，以胰岛素抵抗、β细胞功能或T2D发病率作为结果的研究均符合条件。采用随机效应模型估算了汇总相对风险（RR）或平均差异（MD）及 95% 置信区间（CI）。证据的确定性采用 GRADE 进行评估。在筛选出的 6,190 份记录中，有 25 项前瞻性观察研究和 15 项 RCT 符合条件。研究发现，膳食和循环中的抗氧化剂与 T2D 之间存在反向关系（观察性研究）。维生素 C 摄入量达到 70 毫克/天（RR：0.76；CI 0.61，0.95）、维生素 E 摄入量达到 12 毫克/天（RR：0.72；CI 0.61，0.86）、β-胡萝卜素摄入量达到 4 毫克/天（RR：0.78；CI 0.65，0.94）时，风险最低。补充维生素 E（RR：1.01；CI 0.93，1.10）或 β-胡萝卜素（RR：0.98；CI 0.90，1.07）对 T2D 没有保护作用（RCTs），而补充维生素 C 的数据有限。关于胰岛素抵抗，膳食中摄入较多的维生素 C（RR：0.85；CI：0.74，0.98）和补充维生素 E（MD：-0.35；CI：-0.65，-0.06）与降低风险有关。T2D与膳食维生素E和β-胡萝卜素之间的关联证据的确定性较高，而与其他关联的证据的确定性为低到中等。总之，适量摄入维生素C、E和β-胡萝卜素可通过降低胰岛素抵抗来降低T2D风险。在研究性试验中，补充维生素C、E和β-胡萝卜素缺乏保护作用，这表明在预防T2D方面，适量而非大量摄入维生素C、E和β-胡萝卜素可能会发挥作用。系统综述或荟萃分析的注册表和注册表编号：PROSPERO(CRD42022343482).

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来源期刊

Advances in Nutrition 医学-营养学

CiteScore

17.40

自引率

2.20%

发文量

117

审稿时长

56 days

期刊介绍： Advances in Nutrition (AN/Adv Nutr) publishes focused reviews on pivotal findings and recent research across all domains relevant to nutritional scientists and biomedical researchers. This encompasses nutrition-related research spanning biochemical, molecular, and genetic studies using experimental animal models, domestic animals, and human subjects. The journal also emphasizes clinical nutrition, epidemiology and public health, and nutrition education. Review articles concentrate on recent progress rather than broad historical developments. In addition to review articles, AN includes Perspectives, Letters to the Editor, and supplements. Supplement proposals require pre-approval by the editor before submission. The journal features reports and position papers from the American Society for Nutrition, summaries of major government and foundation reports, and Nutrient Information briefs providing crucial details about dietary requirements, food sources, deficiencies, and other essential nutrient information. All submissions with scientific content undergo peer review by the Editors or their designees prior to acceptance for publication.