Eating more whole grains and fish may lower all-cause mortality risk in type 2 diabetes
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Eating fish, whole grains and foods that are high in fiber and omega-3 polyunsaturated fatty acids may reduce the risk for death from any cause for people with type 2 diabetes, according to a speaker.
In findings from a meta-analysis presented at the European Association for the Study of Diabetes annual meeting, eating more vegetables and plant protein was also linked to a reduced risk for all-cause mortality in type 2 diabetes, whereas eating more eggs and high concentrations of cholesterol may increase the risk for death. However, some of the associations in the meta-analysis had a low certainty of evidence, making future research paramount.
“The findings indicate that individuals with type 2 diabetes should be advised to follow a healthy diet,” Janett Barbaresko, PhD, and Sabrina Schlesinger, PhD, of the Institute for Biometrics and Epidemiology at the German Diabetes Center in Dusseldorf, Germany, told Healio. “However, more research is still needed to strengthen the results and to provide recommendations that are more specific.”
Researchers conducted a systematic review and meta-analysis of observational studies analyzing the effects of any dietary factors on all-cause mortality in adults with type 2 diabetes. The PubMed and Web of Science databases were searched from inception until June 2022. Pairwise and dose-responses meta-analyses were conducted to calculate summary risk ratios for each dietary factor.
There were 107 studies included in the systematic review and 82 studies included in the meta-analysis with a mean study cohort of 5,879 participants. Of the 107 studies, 42 were conducted in the U.S., 37 in Europe, 24 in Asia, three were international studies and one was conducted in Australia.
Of dietary factors that had a moderate certainty of evidence, eating one serving of fish per week (RR = 0.95; 95% CI, 0.92-0.99) and eating 20 g whole grain per day (RR = 0.84; 95% CI, 0.71-0.99) were associated with reduced risk for all-cause mortality. Eating 5 g fiber per day (RR = 0.86; 95% CI, 0.81-0.91) and 0.1 g omega-3 polyunsaturated fatty acids (RR = 0.87; 95% CI, 0.82-0.92) were also associated with a lower risk for death.
Adults with type 2 diabetes have a lower risk for all-cause mortality with each daily serving of 100 g vegetables (RR = 0.88; 95% CI, 0.82-0.94) and 10 g plant protein (RR = 0.91; 95% CI, 0.87-0.96). An increased risk for all-cause mortality was observed for adults eating 10 g eggs per day (RR = 1.05; 95% CI, 1.03-1.08) and 300 mg cholesterol per day (RR = 1.19; 95% CI, 1.13-1.26). However, the associations between vegetables, plant protein, eggs and cholesterol with all-cause mortality had a low certainty of evidence. For other dietary factors examined in the study, evidence was limited and had either a low or very low certainty.
“More primary studies are needed to strengthen the evidence for many dietary factors, such as dietary patterns like the Mediterranean diet, foods and micronutrients,” Barbaresko and Schlesinger said. “In this context, future studies should use validated dietary assessment instruments to collect reliable dietary intake data and future studies should include participants with newly diagnosed type 2 diabetes to minimize selection bias. Moreover, future studies should collect and account for important confounders that could influence the associations, with the aim to decrease risk of bias and increase overall certainty of evidence.”
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Barbaresko J, et al. OP 01. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 19-23, 2022; Stockholm (hybrid meeting).
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