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The effect of nuts on markers of glycemic control: a systematic review and meta-analysis of randomized controlled trials.

ABSTRACT: Background:Observational evidence suggests higher nut consumption is associated with better glycemic control; however, it is unclear if this association is causal. Objectives:We aimed to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effect of tree nuts and peanuts on markers of glycemic control in adults. Methods:A systematic review and meta-analysis of randomized controlled trials was conducted. A total of 1063 potentially eligible articles were screened in duplicate. From these articles, 40 were eligible for inclusion and data from these articles were extracted in duplicate. The weighted mean difference (WMD) between the nut intervention and control arms was determined for fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and homeostasis model assessment of insulin resistance (HOMA-IR) using the DerSimonian and Laird random-effects method. For outcomes where a limited number of studies were published, a qualitative synthesis was presented. Results:A total of 40 randomized controlled trials including 2832 unique participants, with a median duration of 3 mo (range: 1-12 mo), were included. Overall consumption of tree nuts or peanuts had a favorable effect on HOMA-IR (WMD: -0.23; 95% CI: -0.40, -0.06; I2 = 51.7%) and fasting insulin (WMD: -0.40 ?IU/mL; 95% CI: -0.73, -0.07 ?IU/mL; I2 = 49.4%). There was no significant effect of nut consumption on fasting blood glucose (WMD: -0.52 mg/dL; 95% CI: -1.43, 0.38 mg/dL; I2 = 53.4%) or HbA1c (WMD: 0.02%; 95% CI: -0.01%, 0.04%; I2 = 51.0%). Conclusions:Consumption of peanuts or tree nuts significantly decreased HOMA-IR and fasting insulin; there was no effect of nut consumption on HbA1c or fasting glucose. The results suggest that nut consumption may improve insulin sensitivity. In the future, well-designed clinical trials are required to elucidate the mechanisms that account for these observed effects.

SUBMITTER: Tindall AM

PROVIDER: S-EPMC7307437 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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The effect of nuts on markers of glycemic control: a systematic review and meta-analysis of randomized controlled trials.

Tindall Alyssa M AM Johnston Emily A EA Kris-Etherton Penny M PM Petersen Kristina S KS

The American journal of clinical nutrition 20190201 2

<h4>Background</h4>Observational evidence suggests higher nut consumption is associated with better glycemic control; however, it is unclear if this association is causal.<h4>Objectives</h4>We aimed to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effect of tree nuts and peanuts on markers of glycemic control in adults.<h4>Methods</h4>A systematic review and meta-analysis of randomized controlled trials was conducted. A total of 1063 potentially eli ...[more]

PMID: 30722007

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Project description:Abstract Objectives Current approved health claims in Canada, US and Europe recognize the ability of oat ß-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials to update the evidence of the effect of oats and oat-fiber on markers of glycemic control in people with and without diabetes. Here we present data for the subgroup with diabetes. Methods MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through September 23rd, 2020. We included randomized controlled trials of ≥ 2-weeks of sources of oat ß-glucan and measures of glycemic control in diabetes. Two independent reviewers extracted relevant data and assessed the risk of bias (Cochrane Risk of Bias 2.0 Tool). The outcomes were fasting plasma glucose (FPG), 2h-plasma glucose (2h-PG) from a 75 g-oral glucose tolerance test, HbA1c and fasting plasma insulin (FPI). Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Pooled estimates were expressed as mean differences with 95% confidence intervals (CI). GRADE assessed the certainty of the evidence. Results Eligibility criteria were met by 5 trial comparisons (N = 359) in type 2 diabetes. No trials were identified in type 1 diabetes. Consumption of oat ß-glucan sources reduced FPG (MD = −0.37 mmol/L [95% CI: −0.70, −0.05 mmol/L], P = 0.03, I2 = 0.00%, PQ = 0.76) and 2h-PG (MD = −1.24 mmol/L [95% CI: −1.97, −0.51 mmol/L], P = 0.00, I2 = 0.00%, PQ = 0.56). There were non-significant reductions in HbA1c (MD = −0.12%, [95% CI: −0.26, 0.01%], P = 0.07, I2 = 0.00%, PQ = 1.00) and FPI (MD = −4.59 pmol/L, [95% CI: −14.71, 5.52 pmol/L], P = 0.37, I2 = 40.84%, PQ = 0.19). The certainty of evidence was high for 2h-PG and moderate for FPG, HbA1c and FPI (single downgrades for imprecision in each case). Conclusions Current evidence provides a good indication that consumption of oat ß-glucan results in small improvements of glycemic control in type 2 diabetes. More high quality randomized trials are required to improve the precision of the pooled estimates. (ClinicalTrials.gov identifier, NCT04631913) Funding Sources Quaker Oats Center of Excellence, Diabetes Canada, Banting & Best Diabetes Centre, Toronto 3D foundation

Project description:ImportanceDespite the widespread use of ginseng in the management of diabetes, supporting evidence of its anti-hyperglycemic efficacy is limited, necessitating the need for evidence-based recommendations for the potential inclusion of ginseng in diabetes management.ObjectiveTo elucidate the effect of ginseng on glycemic control in a systematic review and meta-analysis of randomized controlled trials in people with and without diabetes.Data sourcesMEDLINE, EMBASE, CINAHL and the Cochrane Library (through July 3, 2013).Study selectionRandomized controlled trials ≥30 days assessing the glycemic effects of ginseng in people with and without diabetes.Data extractionRelevant data were extracted by 2 independent reviewers. Discrepancies were resolved by consensus. The Heyland Methodological Quality Score and the Cochrane risk of bias tool were used to assess study quality and risk of bias respectively.Data synthesisSixteen trials were included, in which 16 fasting blood glucose (n = 770), 10 fasting plasma insulin (n = 349), 9 glycated hemoglobin (n = 264), and 7 homeostasis model assessment of insulin resistance (n = 305) comparisons were reported. Ginseng significantly reduced fasting blood glucose compared to control (MD = -0.31 mmol/L [95% CI: -0.59 to -0.03], P = 0.03). Although there was no significant effect on fasting plasma insulin, glycated hemoglobin, or homeostasis model assessment of insulin resistance, a priori subgroup analyses did show significant reductions in glycated hemoglobin in parallel compared to crossover trials (MD = 0.22% [95%CI: 0.06 to 0.37], P = 0.01).LimitationsMost trials were of short duration (67% trials<12wks), and included participants with a relatively good glycemic control (median HbA1c non-diabetes = 5.4% [2 trials]; median HbA1c diabetes = 7.1% [7 trials]).ConclusionsGinseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. In order to address the uncertainty in our effect estimates and provide better assessments of ginseng's anti-diabetic efficacy, larger and longer randomized controlled trials using standardized ginseng preparations are warranted.Trial registrationClinicalTrials.gov NCT01841229.

Project description:Evidence regarding the effect of isomaltulose on glycemic and insulinemic responses is still conflicting, which limits isomaltulose's application in glycemic management. The purpose of this study was to comprehensively evaluate its effectiveness and evidence quality. We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) prior to October 2021. RCTs were eligible for inclusion if they enrolled adults to oral intake of isomaltulose or other carbohydrates dissolved in water after an overnight fast and compared their 2-h postprandial glucose and insulin concentrations. The DerSimonian-Laird method was used to pool the means of the circulating glucose and insulin concentrations. Both random-effects and fixed-effects models were used to calculate the weighted mean difference in postprandial glucose and insulin concentrations in different groups. Subgroup, sensitivity, and meta-regression analyses were also conducted. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. Finally, 11 RCTs (n = 175 participants) were included. The trials were conducted in 4 countries (Japan, Brazil, Germany, and the Netherlands), and all of the enrolled participants were >18 y of age with various health statuses (healthy, type 2 diabetes, impaired glucose tolerance, and hypertension). Moderate evidence suggested that oral isomaltulose caused an attenuated glycemic response compared with sucrose at 30 min. Low evidence suggested that oral isomaltulose caused an attenuated but more prolonged glycemic response than sucrose and an attenuated insulinemic response. Low-to-moderate levels of evidence suggest there may be more benefit of isomaltulose for people with type 2 diabetes, impaired glucose tolerance, or hypertension; older people; overweight or obese people; and Asian people. The study was registered on PROSPERO (International Prospective Register of Systematic Reviews) as CRD42021290396 (available at https://www.crd.york.ac.uk/prospero/).

Project description:Polyunsaturated fats (PUFAs) have been shown to reduce type 2 diabetes (T2DM) risk and improve insulin responsiveness in T2DM subjects, but whether the plant sources of omega-3 PUFA (alpha-linolenic acid [ALA]) have an effect on glycemic control requires further investigation.The parameters of interest were glycated hemoglobin (HbA1c), fasting blood glucose (FBG), fasting blood insulin (FBI), homeostatic model assessment for insulin resistance (HOMA-IR), fructosamine, and glycated albumin. A comprehensive search was conducted with MEDLINE, Embase, CINAHL, and Cochrane. Eligible studies included randomized controlled trials (RCTs) ?1 month in duration that compared diets enriched in ALA with usual diets on glycemic parameters. For each study, the risk of bias as well as the study quality was assessed. Using the statistical software RevMan (v5.3), data were pooled using the generic inverse method with random effects model, and final results were expressed as mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was assessed by the Cochran Q statistic and quantified by the I statistic.A total of 8 trials (N?=?212) were included in the meta-analysis. Compared to a control diet, a median dose of 4.4?g/day of ALA intake for a median duration of 3 months did not affect HbA1c (%) (MD?=?-.01; [95%: -.32, .31], P?=?.96). A median ALA dose of 5.4?g/day did not lower FBG (MD?=?.07; [95% CI: -.61, .76], P?=?.84) or FBI (MD?=?7.03, [95% CI: -5.84, 19.89], P?=?.28). Summary effect estimates were generally compromised by considerable and unexplained heterogeneity (I ?75%). In the subgroup analysis of continuous predictors, a reduction in HbA1c (%) and FBG (mmol/L) was significantly associated with an increased intake of ALA. Further adjustment for Publication Bias using Duval and Tweedie's trim-and-fill analysis provided an adjusted, significant MD of -.25 (95% CI: -.38, -.12; P?<.001) for HbA1c (%).ALA-enriched diets did not affect HbA1c, FBG, or FBI. The scarce number of existing RCTs and the presence of heterogeneity in our meta-analysis limit the ability to make firm conclusions about ALA in T2DM management. The potential for ALA to have dose-dependent effects warrants further research in this area.

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The effect of nuts on markers of glycemic control: a systematic review and meta-analysis of randomized controlled trials.

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The effect of nuts on markers of glycemic control: a systematic review and meta-analysis of randomized controlled trials.

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