乳制品摄入量与糖尿病前期和持续血糖结果的关系：前瞻性队列研究的系统回顾与剂量反应元分析

IF 3.8 Q2 NUTRITION & DIETETICS

Current Developments in Nutrition Pub Date : 2024-11-01 DOI:10.1016/j.cdnut.2024.104470

Isabel AL Slurink , Yakima D Vogtschmidt , Bo Brummel , Tom Smeets , Nina Kupper , Sabita S Soedamah-Muthu

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引用次数: 0

摘要

背景研究发现，乳制品（尤其是酸奶）的摄入量与 2 型糖尿病的发病风险呈反比关系。本研究旨在调查不同类型乳制品的摄入量、糖尿病前期风险和连续血糖结果之间的关系。方法通过多个数据库对截至 2023 年 9 月发表的研究进行了系统的文献检索。纳入的前瞻性队列研究以健康成年人为对象，根据诊断标准或连续血糖指标研究了乳制品摄入量与糖尿病前期风险之间的关系。通过剂量-反应随机效应荟萃分析，得出了总乳制品、发酵乳制品、牛奶、酸奶、奶酪（所有总奶酪、高脂奶酪和低脂奶酪）、奶油和冰淇淋与糖尿病前期风险之间的增量相对风险系数（RRs），并对社会人口学、健康和心脏代谢风险因素以及饮食特点进行了调整。结果荟萃分析涵盖了 95,844 人（年龄在 45.5-65.5 岁之间）中的 6653 例糖尿病前期病例，其中包括 6 篇文章和 9 个队列。研究发现，乳制品总摄入量与糖尿病前期风险呈二次反比关系，3.4 份/天的风险最低（RR：0.75；95% 置信区间：0.60, 0.93；I2 = 18%）。同样，全脂和高脂奶酪与糖尿病风险呈非线性反向关系，2.1 份/天时风险最低（0.86；0.78，0.94；I2 = 0%，0.90；0.81，0.99；I2 = 12%），但摄入量超过 4 份/天时风险较高。冰淇淋摄入量与糖尿病前期风险呈线性相关（0.85；0.73，0.99；I2 = 0%，摄入量中位数最高为 0.23 份/天）。其他类型的乳制品在统计学上没有显著关联。关于乳制品摄入量和血糖结果的系统综述在设计和结果方面存在很大差异。反向因果关系和残余混杂物的可能性突出表明需要进行全面的重复测量研究。

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Dairy Intake in Relation to Prediabetes and Continuous Glycemic Outcomes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Background

Modest inverse associations have been found between dairy intake, particularly yogurt, and type 2 diabetes risk. Investigating associations of dairy intake with early onset of type 2 diabetes offers opportunities for effective prevention of this condition.

Objectives

This study aims to investigate the relationships between the intake of different dairy types, prediabetes risk, and continuous glycemic outcomes.

Methods

Systematic literature searches across multiple databases were performed of studies published up to September 2023. Included were prospective cohort studies in healthy adults that examined the association between dairy intake and prediabetes risk according to diagnostic criteria, or continuous glycemic markers. A dose-response random-effects meta-analysis was used to derive incremental relative risks (RRs) for associations of total dairy, fermented dairy, milk, yogurt, cheese (all total, high-fat, and low-fat), cream, and ice cream with prediabetes risk adjusted for sociodemographic, health and cardiometabolic risk factors, and dietary characteristics.

Results

The meta-analyses encompassed 6653 prediabetes cases among 95,844 individuals (age range 45.5–65.5 y) including 6 articles describing 9 cohorts. A quadratic inverse association was observed for total dairy intake and prediabetes risk, with the lowest risk at 3.4 servings/d (RR: 0.75; 95% confidence interval: 0.60, 0.93; I² = 18%). Similarly, total, and high-fat cheese exhibited nonlinear inverse associations with prediabetes risk, showing the lowest risk at 2.1 servings/d (0.86; 0.78, 0.94; I² = 0%, and 0.90; 0.81, 0.99; I² = 12%), but a higher risk at intakes exceeding 4 servings/d. Ice cream intake was linearly associated with prediabetes risk (0.85; 0.73, 0.99; I² = 0% at the highest median intake of 0.23 servings/d). Other dairy types showed no statistically significant associations. The systematic review on dairy intake and glycemic outcomes showed considerable variabilities in design and results.

Conclusions

The findings suggest an inverse association between moderate dairy and cheese intake in preventing prediabetes. The potential for reverse causation and residual confounding highlights the need for studies with comprehensive repeated measurements.