Poor quality of dietary assessment in randomised controlled trials of nutritional interventions for type 2 diabetes may impact outcome conclusions: a systematic review
会议名称：《中国营养学会第十五届全国营养科学大会》
会议日期：2022年
学科分类：1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 100215[医学-康复医学与理疗学] 10[医学]
关 键 词：Diet dietary assessment method meta-analysis nutrition intervention systematic review type 2 diabetes mellitus
摘 要：Diet is critical in diabetes management and new nutritional interventions are continuously being tested in randomized controlled trials. However, to make meaningful conclusions about the efficacy of dietary treatments, it is critical to be certain that the participants adhered to the dietary intervention and the dietary changes are valid. The objective of this meta-analysis was to assess the quality of dietary assessment and whether it might impact on study metabolic outcomes. Methods Four databases, MEDLINE, EMBASE, CINAHL and CENTRAL, were searched, from inception until September 2019 for randomized controlled trials of nutritional interventions in people with non-insulin-dependent type 2 diabetes. Trials that measured nutritional intakes in methods and HbA1 c as an outcome were included. Investigators assessed risk of bias and quality of the dietary measurements using the Cochrane Risk of Bias Assessment Tool 2.0 and a redeveloped EURICA tool, respectively. The study was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-analyses. PROSPERO registration number: CRD42019146471. Results Of 2552 records retrieved, 23 studies met the inclusion criteria. Nineteen studies aimed to achieve a reduction in HbA1c, and four studies aimed to maintain HbA1c while improving other metabolic/nutritional outcomes. Two studies were rated as ’good’, six as ’medium’, and 15 as ‘poor’ in the quality assessment of the dietary measurement tool. The majority of studies were rated as high risk of bias. Of those studies with medium or high diet quality assessment, six of eight achieved the desired outcome whereas only four of the 15 other studies achieved the desired clinical outcome for HbA1 c. Conclusion The poor quality of dietary assessment in clinical trials manipulating dietary intakes casts uncertainty on the legitimacy of causal mechanisms attributed to dietary interventions. Attention to the validity and reliability of dietary assessment methods is