Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses

Autoři: Andrew N. Reynolds aff001;  Ashley P. Akerman aff001;  Jim Mann aff001
Působiště autorů: Department of Medicine, University of Otago, Dunedin, Otago, New Zealand aff001;  Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand aff002;  School of Physical Education, Sports, and Exercise Science, University of Otago, Dunedin, New Zealand aff003
Vyšlo v časopise: Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Med 17(3): e1003053. doi:10.1371/journal.pmed.1003053
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003053



Fibre is promoted as part of a healthy dietary pattern and in diabetes management. We have considered the role of high-fibre diets on mortality and increasing fibre intake on glycaemic control and other cardiometabolic risk factors of adults with prediabetes or diabetes.

Methods and findings

We conducted a systematic review of published literature to identify prospective studies or controlled trials that have examined the effects of a higher fibre intake without additional dietary or other lifestyle modification in adults with prediabetes, gestational diabetes, type 1 diabetes, and type 2 diabetes. Meta-analyses were undertaken to determine the effects of higher fibre intake on all-cause and cardiovascular mortality and increasing fibre intake on glycaemic control and a range of cardiometabolic risk factors. For trials, meta regression analyses identified further variables that influenced the pooled findings. Dose response testing was undertaken; Grading of Recommendations Assessment, Development and Evaluation (GRADE) protocols were followed to assess the quality of evidence. Two multicountry cohorts of 8,300 adults with type 1 or type 2 diabetes followed on average for 8.8 years and 42 trials including 1,789 adults with prediabetes, type 1, or type 2 diabetes were identified. Prospective cohort data indicate an absolute reduction of 14 fewer deaths (95% confidence interval (CI) 4–19) per 1,000 participants over the study duration, when comparing a daily dietary fibre intake of 35 g with the average intake of 19 g, with a clear dose response relationship apparent. Increased fibre intakes reduced glycated haemoglobin (HbA1c; mean difference [MD] −2.00 mmol/mol, 95% CI −3.30 to −0.71 from 33 trials), fasting plasma glucose (MD −0.56 mmol/L, 95% CI −0.73 to −0.38 from 34 trials), insulin (standardised mean difference [SMD] −2.03, 95% CI −2.92 to −1.13 from 19 trials), homeostatic model assessment of insulin resistance (HOMA IR; MD −1.24 mg/dL, 95% CI −1.72 to −0.76 from 9 trials), total cholesterol (MD −0.34 mmol/L, 95% CI −0.46 to −0.22 from 27 trials), low-density lipoprotein (LDL) cholesterol (MD −0.17 mmol/L, 95% CI −0.27 to −0.08 from 21 trials), triglycerides (MD −0.16 mmol/L, 95% CI −0.23 to −0.09 from 28 trials), body weight (MD −0.56 kg, 95% CI −0.98 to −0.13 from 18 trials), Body Mass Index (BMI; MD −0.36, 95% CI −0·55 to −0·16 from 14 trials), and C-reactive protein (SMD −2.80, 95% CI −4.52 to −1.09 from 7 trials) when compared with lower fibre diets. All trial analyses were subject to high heterogeneity. Key variables beyond increasing fibre intake were the fibre intake at baseline, the global region where the trials were conducted, and participant inclusion criteria other than diabetes type. Potential limitations were the lack of prospective cohort data in non-European countries and the lack of long-term (12 months or greater) controlled trials of increasing fibre intakes in adults with diabetes.


Higher-fibre diets are an important component of diabetes management, resulting in improvements in measures of glycaemic control, blood lipids, body weight, and inflammation, as well as a reduction in premature mortality. These benefits were not confined to any fibre type or to any type of diabetes and were apparent across the range of intakes, although greater improvements in glycaemic control were observed for those moving from low to moderate or high intakes. Based on these findings, increasing daily fibre intake by 15 g or to 35 g might be a reasonable target that would be expected to reduce risk of premature mortality in adults with diabetes.

Klíčová slova:

Carbohydrates – Cohort studies – Diabetes mellitus – HbA1c – Cholesterol – Medical risk factors – Regression analysis – Type 2 diabetes


1. Kiehm TG, Anderson JW, Ward K. Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J Clin Nutr. 1976;29(8):895–9. Epub 1976/08/01. doi: 10.1093/ajcn/29.8.895 941870.

2. Anderson JW, Ward K. Long-term effects of high-carbohydrate, high-fiber diets on glucose and lipid metabolism: a preliminary report on patients with diabetes. Diabetes Care. 1978;1(2):77–82. Epub 1978/03/01. doi: 10.2337/diacare.1.2.77 729433.

3. Anderson JW. High carbohydrate, high fiber diets for patients with diabetes. Advances in Experimental Medicine and Biology. 1979;119:263–73. Epub 1979/01/01. doi: 10.1007/978-1-4615-9110-8_38 495284.

4. Kempner W, Peschel RL, Schlayer C. Effect of rice diet on diabetes mellitus associated with vascular disease. Postgraduate Medicine. 1958;24(4):359–71. Epub 1958/10/01. doi: 10.1080/00325481.1958.11692236 13591100.

5. Truswell AS, Thomas BJ, Brown AM. Survey of dietary policy and management in British diabetic clinics. BMJ. 1975;4(5987):7–11. Epub 1975/10/04. doi: 10.1136/bmj.4.5987.7 1174929; PubMed Central PMCID: PMC1674774.

6. Connor WE, Connor SL. The Dietary Treatment of Hyperlipidemia: Rationale, Technique and Efficacy. Medical Clinics of North America. 1982;66(2):485–518. doi: 10.1016/s0025-7125(16)31432-8 6279984

7. Simpson RW, Mann JI, Eaton J, Carter RD, Hockaday TD. High-carbohydrate diets and insulin-dependent diabetics. BMJ. 1979;2(6189):523–5. Epub 1979/09/01. doi: 10.1136/bmj.2.6189.523 497671; PubMed Central PMCID: PMC1596170.

8. Riccardi G, Rivellese A, Pacioni D, Genovese S, Mastranzo P, Mancini M. Separate influence of dietary carbohydrate and fibre on the metabolic control in diabetes. Diabetologia. 1984;26(2):116–21. Epub 1984/02/01. doi: 10.1007/bf00281117 6325282.

9. Rivellese A, Riccardi G, Giacco A, Pacioni D, Genovese S, Mattioli PL, et al. Effect of dietary fibre on glucose control and serum lipoproteins in diabetic patients. Lancet. 1980;2(8192):447–50. Epub 1980/08/30. doi: 10.1016/s0140-6736(80)91886-3 6106098.

10. Parillo M, Riccardi G, Pacioni D, Iovine C, Contaldo F, Isernia C, et al. Metabolic consequences of feeding a high-carbohydrate, high-fiber diet to diabetic patients with chronic kidney failure. Am J Clin Nutr. 1988;48(2):255–9. Epub 1988/08/01. doi: 10.1093/ajcn/48.2.255 2841839.

11. Simpson HC, Simpson RW, Lousley S, Carter RD, Geekie M, Hockaday TD, et al. A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet. 1981;1(8210):1–5. Epub 1981/01/03. doi: 10.1016/s0140-6736(81)90112-4 6109047.

12. Mann J. Lines to legumes: changing concepts of diabetic diets. Diabetic Medicine. 1984;1(3):191–8. doi: 10.1111/j.1464-5491.1984.tb01952.x 6242797

13. Silva FM, Kramer CK, de Almeida JC, Steemburgo T, Gross JL, Azevedo MJ. Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutrition Reviews. 2013;71(12):790–801. doi: 10.1111/nure.12076 24180564

14. Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. New England Journal of Medicine. 2000;342(19):1392–8. doi: 10.1056/NEJM200005113421903 10805824

15. Jovanovski E, Khayyat R, Zurbau A, Komishon A, Mazhar N, Sievenpiper J, et al. Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2019.

16. McRae MP. Dietary Fiber Intake and Type 2 Diabetes Mellitus: An Umbrella Review of Meta- analyses. Journal of Chiropractic Medicine. 2018;17(1):44–53. doi: 10.1016/j.jcm.2017.11.002 29628808

17. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097 19621072

18. Alimentarius Codex. Guidelines on nutrition labelling. CAC/GL. 1985:2–1985.

19. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. 1 [September 2008]. The Cochrane Collaboration. 2008.

20. Veritas Health Innovation. Covidence systematice review software. Melbourne, Australia; 2017.

21. Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019; 393(10170)434– 445. doi: 10.1016/S0140-6736(18)31809-9 30638909

22. Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2011. oxford. asp; 2011.

23. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343:d5928. doi: 10.1136/bmj.d5928 22008217

24. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials. 1986;7(3):177–88. doi: 10.1016/0197-2456(86)90046-2 3802833

25. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata Journal. 2006;6(1):40.

26. Stephen AM, Champ MM-J, Cloran SJ, Fleith M, Van Lieshout L, Mejborn H, et al. Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutrition Research Reviews. 2017;30(2):149–90. doi: 10.1017/S095442241700004X 28676135

27. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557. doi: 10.1136/bmj.327.7414.557 12958120

28. Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10(1):101–29.

29. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. doi: 10.1136/bmj.315.7109.629 9310563

30. Duval S, Tweedie R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics. 2000;56(2):455–63. doi: 10.1111/j.0006-341x.2000.00455.x 10877304

31. StataCorp. Stata Statistical Software: Release 15. College Station. TX: StataCorp LP; 2017.

32. R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundations for Statistical Computing; 2017.

33. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924. doi: 10.1136/bmj.39489.470347.AD 18436948

34. Schoenaker DAM, Toeller M, Chaturvedi N, Fuller JH, Soedamah-Muthu SS, Group EPCS. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia. 2012;55(8):2132–41. doi: 10.1007/s00125-012-2550-0 22526612

35. Burger KN, Beulens JW, van der Schouw YT, Sluijs I, Spijkerman AM, Sluik D, et al. Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus. PLoS ONE. 2012;7(8):e43127. doi: 10.1371/journal.pone.0043127 22927948

36. Giacco R, Parillo M, Rivellese AA, Lasorella G, Giacco A, D'Episcopo L, et al. Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care. 2000;23(10):1461–6. doi: 10.2337/diacare.23.10.1461 11023137

37. Venhaus A, Chantelau E. Self-selected unrefined and refined carbohydrate diets do not affect metabolic control in pump-treated diabetic patients. Diabetologia. 1988;31(3):153–7. doi: 10.1007/bf00276848 3286342

38. Hagander B, Asp N-G, Efendić S, Nilsson-Ehle P, Scherstén B. Dietary fiber decreases fasting blood glucose levels and plasma LDL concentration in noninsulin-dependent diabetes mellitus patients. Am J Clin Nutr. 1988;47(5):852–8. doi: 10.1093/ajcn/47.5.852 2834942

39. Hagander B, Asp N, Ekman R, Nilsson-Ehle P, Scherstén B. Dietary fibre enrichment, blood pressure, lipoprotein profile and gut hormones in NIDDM patients. Eu J Clin Nutr. 1989;43(1):35–44.

40. Jenkins DJ, Kendall CW, Augustin LS, Martini MC, Axelsen M, Faulkner D, et al. Effect of wheat bran on glycemic control and risk factors for cardiovascular disease in type 2 diabetes. Diabetes Care. 2002;25(9):1522–8. doi: 10.2337/diacare.25.9.1522 12196421

41. Karlander S, Armyr I, Efendic S. Metabolic effects and clinical value of beet fiber treatment in NIDDM patients. Diabetes Research and Clinical Practice. 1991;11(2):65–71. doi: 10.1016/0168-8227(91)90093-s 1850691

42. Lalor B, Bhatnagar D, Winocour P, Ishola M, Arrol S, Brading M, et al. Placebo‐controlled trial of the effects of guar gum and metformin on fasting blood glucose and serum lipids in obese, type 2 diabetic patients. Diabetic Medicine. 1990;7(3):242–5. doi: 10.1111/j.1464-5491.1990.tb01378.x 2158410

43. Pick ME, Hawrysh ZJ, Gee MI, Toth E, Garg ML, Hardin RT. Oat bran concentrate bread products improve long-term control of diabetes: A pilot study. Journal of the American Dietetic Association. 1996;96(12):1254–61. doi: 10.1016/S0002-8223(96)00329-X 8948386.

44. Uusitupa M, Siitonen O, Savolainen K, Silvasti M, Penttila I, Parviainen M. Metabolic and nutritional effects of long-term use of guar gum in the treatment of noninsulin-dependent diabetes of poor metabolic control. Am J Clin Nutr. 1989;49(2):345–51. doi: 10.1093/ajcn/49.2.345 2537003.

45. Peterson DB, Ellis PR, Baylis JM. Low dose guar in a novel food product: Improved metabolic control in non-insulin-dependent diabetes. Diabetic Medicine. 1987;4(2):111–5. doi: 10.1111/j.1464-5491.1987.tb00843.x 2952426.

46. Cugnet-Anceau C, Nazare J-A, Biorklund M, Le Coquil E, Sassolas A, Sothier M, et al. A controlled study of consumption of β-glucan-enriched soups for 2 months by type 2 diabetic free-living subjects. British Journal of Nutrition. 2010;103(3):422–8. doi: 10.1017/S0007114509991875 19781120

47. Sartore G, Reitano R, Barison A, Magnanini P, Cosma C, Burlina S, et al. The effects of psyllium on lipoproteins in type II diabetic patients. Eu J Clin Nutr. 2009;63(10):1269–71. 50588023.

48. Li X, Cai X, Ma X, Jing L, Gu J, Bao L, et al. Short-and long-term effects of wholegrain oat intake on weight management and glucolipid metabolism in overweight type-2 diabetics: a randomized control trial. Nutrients. 2016;8(9):549.

49. Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutrition Journal. 2016;15(1):86. doi: 10.1186/s12937-016-0207-4 27733151

50. Aro A, Uusitupa M, Voutilainen E, Hersio K, Korhonen T, Siitonen O. Improved diabetic control and hypocholesterolaemic effect induced by long-term dietary supplementation with guar gum in type 2 (insulin-independent) diabetes. Diabetologia. 1981;21(1):29–33. doi: 10.1007/bf03216219 6268475

51. Chuang L-M, Jou T, Yang W, Wu H, Huang S, Tai T, et al. Therapeutic effect of guar gum in patients with non-insulin-dependent diabetes mellitus. Journal of the Formosan Medical Association. 1992;91(1):15–9. 1352328

52. Diaz J, Durruty P, Tapia J, Carrasco E, Riesco V, Durruty G, et al. The effects of a dietary fiber (white lupine bran) in the treatment of non-insulin-dependent diabetes. Revista Medica de Chile. 1990;118(1):24–32. Not available in English. 1967111

53. Aliasgharzadeh A, Dehghan P, Gargari BP, Asghari-Jafarabadi M. Resistant dextrin, as a prebiotic, improves insulin resistance and inflammation in women with type 2 diabetes: a randomised controlled clinical trial. British Journal of Nutrition. 2015;113(2):321–30. doi: 10.1017/S0007114514003675 27028002

54. Dall'Alba V, Silva FM, Antonio JP, Steemburgo T, Royer CP, Almeida JC, et al. Improvement of the metabolic syndrome profile by soluble fibre–guar gum–in patients with type 2 diabetes: a randomised clinical trial. British Journal of Nutrition. 2013;110(9):1601–10. doi: 10.1017/S0007114513001025 23551992

55. Dehghan P, Pourghassem Gargari B, Faghfoori Z, Salekzamani S, Jafarabadi M. Comparative effect of inulin and oligofructose-enriched inulin on glycemic indices and blood pressure in women with type 2 diabetes: a randomized clinical trial. ZUMS Journal. 2014;22(91):25–38. Not available in English.

56. Feinglos MN, Gibb RD, Ramsey DL, Surwit RS, McRorie JW. Psyllium improves glycemic control in patients with type-2 diabetes mellitus. Bioactive Carbohydrates and Dietary Fibre. 2013;1(2):156–61.

57. Gargari BP, Namazi N, Khalili M, Sarmadi B, Jafarabadi MA, Dehghan P. Is there any place for resistant starch, as alimentary prebiotic, for patients with type 2 diabetes? Complementary Therapies in Medicine. 2015;23(6):810–5. doi: 10.1016/j.ctim.2015.09.005 26645521

58. Grunberger G, Jen KLC, Artiss JD. The benefits of early intervention in obese diabetic patients with FBCx™—a new dietary fibre. Diabetes/Metabolism Research and Reviews. 2007;23(1):56–62. doi: 10.1002/dmrr.687 17013969

59. Kondo K, Morino K, Nishio Y, Ishikado A, Arima H, Nakao K, et al. Fiber-rich diet with brown rice improves endothelial function in type 2 diabetes mellitus: A randomized controlled trial. PLoS ONE. 2017;12(6):e0179869. doi: 10.1371/journal.pone.0179869 28662074

60. Moustafa TA, Kamel HS, El Malt MA. High dietary fibre intake (Talbina) as adjunct in the management of diabetic macular edema. Journal of Medical Sciences. 2007;7(1):81–7. 46138725.

61. Pedersen C, Gallagher E, Horton F, Ellis RJ, Ijaz UZ, Wu H, et al. Host-microbiome interactions in human type 2 diabetes following prebiotic fibre (galacto-oligosaccharide) intake. British Journal of Nutrition. 2016;116(11):1869–77. doi: 10.1017/S0007114516004086 27974055.

62. Stahl M, Berger W. [Comparison of guar gum, wheat bran and placebo on carbohydrate and lipid metabolism in type II diabetics]. Schweizerische Medizinische Wochenschrift. 1990;120(12):402–8. Epub 1990/03/24. 2157279. Not available in English.

63. Calvo-Rubio MB, Montero FP, Campos LS, Barco CE, Ruiz JA, Tapia GB. Use of guar gum as a supplement to the usual diet in type 2 diabetes. A long-term study. Atencion Primaria. 1989;6:20–1, 4–5, 8–30. 2562387

64. Feldheim W, Wisker E. Dietary fibre and type 2 diabetes mellitus. Forum of Nutrition. 56:174–6. 15806849.

65. Lankinen M, Schwab U, Kolehmainen M, Paananen J, Poutanen K, Mykkänen H, et al. Whole grain products, fish and bilberries alter glucose and lipid metabolism in a randomized, controlled trial: the Sysdimet study. PLoS ONE. 2011;6(8):e22646. doi: 10.1371/journal.pone.0022646 21901116

66. Daimon M, Oizumi T, Kato T, Kuge T, Tsubaki K, Kinoshita T, et al. Effect of beta-glucan enriched barley flour on impaired glucose tolerance and safety evaluation of the product. Japanese Pharmacology and Therapeutics. 2011;39(1):101–8. CN-01016487. Not available in English.

67. Canfora EE, van der Beek CM, Hermes GD, Goossens GH, Jocken JW, Holst JJ, et al. Supplementation of diet with galacto-oligosaccharides increases bifidobacteria, but not insulin sensitivity, in obese prediabetic individuals. Gastroenterology. 2017;153(1):87–97. e3. doi: 10.1053/j.gastro.2017.03.051 28396144

68. Errazuriz I, Dube S, Slama M, Visentin R, Nayar S, O’connor H, et al. Randomized controlled trial of a MUFA or fiber-rich diet on hepatic fat in prediabetes. The Journal of Clinical Endocrinology & Metabolism. 2017;102(5):1765–74.

69. Garcia A, Otto B, Reich S, Weickert M, Steiniger J, Machowetz A, et al. Arabinoxylan consumption decreases postprandial serum glucose, serum insulin and plasma total ghrelin response in subjects with impaired glucose tolerance. Eu J Clin Nutr. 2007;61(3):334.

70. Kobayakawa A, Suzuki T, Ikami T, Saito M, Yabe D, Seino Y. Improvement of fasting plasma glucose level after ingesting moderate amount of dietary fiber in Japanese men with mild hyperglycemia and visceral fat obesity. Journal of Dietary Supplements. 2013;10(2):129–41. doi: 10.3109/19390211.2013.790335 23725526

71. Kang R, Kim M, Chae JS, Lee S-H, Lee JH. Consumption of whole grains and legumes modulates the genetic effect of the APOA5-1131C variant on changes in triglyceride and apolipoprotein AV concentrations in patients with impaired fasting glucose or newly diagnosed type 2 diabetes. Trials. 2014;15(1):100.

72. Kim M, Jeung SR, Jeong T-S, Lee S-H, Lee JH. Replacing with whole grains and legumes reduces Lp-PLA2 activities in plasma and PBMCs in patients with prediabetes or T2D. Journal of Lipid Research. 2014;55(8):1762–71. doi: 10.1194/jlr.M044834 24904022

73. Schwab U, Louheranta A, Törrönen A, Uusitupa M. Impact of sugar beet pectin and polydextrose on fasting and postprandial glycemia and fasting concentrations of serum total and lipoprotein lipids in middle-aged subjects with abnormal glucose metabolism. Eu J Clin Nutr. 2006;60(9):1073.

74. Babiker R, Elmusharaf K, Keogh MB, Banaga AS, Saeed AM. Metabolic effect of gum Arabic (Acacia Senegal) in patients with type 2 diabetes mellitus (T2DM): randomized, placebo controlled double blind trial. Functional Foods in Health and Disease. 2017;7(3):222–34.

75. Peterson CM, Beyl RA, Marlatt KL, Martin CK, Aryana KJ, Marco ML, et al. Effect of 12 wk of resistant starch supplementation on cardiometabolic risk factors in adults with prediabetes: a randomized controlled trial. Am J Clin Nutr. 2018;108(3):492– 501. doi: 10.1093/ajcn/nqy121 30010698

76. Roshanravan N, Mahdavi R, Alizadeh E, Jafarabadi MA, Hedayati M, Ghavami A, et al. Effect of butyrate and inulin supplementation on glycemic status, lipid profile and glucagon-like peptide 1 level in patients with type 2 diabetes: A randomized double-blind, placebo- controlled trial. Hormone and Metabolic Research. 2017;49(11):886–91. doi: 10.1055/s-0043-119089 28962046

77. Dodson P, Pacy P, Bal P, Kubicki A, Fletcher R, Taylor K. A controlled trial of a high fibre, low fat and low sodium diet for mild hypertension in Type 2 (non-insulin-dependent) diabetic patients. Diabetologia. 1984;27(5):522–6. doi: 10.1007/bf00290388 6096193

78. Walker KZ, O'Dea K, Nicholson GC, Muir JG. Dietary composition, body weight, and NIDDM: comparison of high-fiber, high-carbohydrate, and modified-fat diets. Diabetes Care. 1995;18(3):401–3. doi: 10.2337/diacare.18.3.401 7555486

79. Hesse D, Hartoft-Nielsen M, Snorgaard O, Perrild H, Rasmussen A, Feldt-Rasmussen U. The effect of soluble dietary fibers on glycemic regulation and lipid status in patients with type 2 diabetes mellitus. Ugeskrift for Laeger. 2004;166(20):1899–902. 15202379

80. Ziai SA, Larijani B, Akhoondzadeh S, Fakhrzadeh H, Dastpak A, Bandarian F, et al. Psyllium decreased serum glucose and glycosylated hemoglobin significantly in diabetic outpatients. Journal of Ethnopharmacology. 2005;102(2):202–7. doi: 10.1016/j.jep.2005.06.042 16154305

81. Niemi MK, Keinänen-Kiukaanniemi SM, Salmela PI. Long-term effects of guar gum and microcrystalline cellulose on glycaemic control and serum lipids in Type 2 diabetes. European Journal of Clinical Pharmacology. 1988;34(4):427–9. doi: 10.1007/bf00542449 3042430

82. Jenkins DJA, Kendall CWC, McKeown-Eyssen G, Josse RG, Silverberg J, Booth GL, et al. Effect of a Low–Glycemic Index or a High–Cereal Fiber Diet on Type 2 Diabetes: A Randomized Trial. JAMA. 2008;300(23):2742–53. doi: 10.1001/jama.2008.808 19088352

83. Simpson H, Carter R, Lousley S, Mann J. Digestible carbohydrate—an independent effect on diabetic control in type 2 (non-insulin-dependent) diabetic patients? Diabetologia. 1982;23(3):235–9. doi: 10.1007/bf00252847 6751903

84. Balk SN, Schoenaker DAJM, Mishra GD, Toeller M, Chaturvedi N, Fuller JH, et al. Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study. Eu J Clin Nutr. 2015;70:229. doi: 10.1038/ejcn.2015.110 26173867

85. Schoenaker DAJM, Toeller M, Chaturvedi N, Fuller JH, Soedamah-Muthu SS, Group tEPCS. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia. 2012;55(8):2132–41. doi: 10.1007/s00125-012-2550-0 22526612

86. Jiang J, Qiu H, Zhao G, Zhou Y, Zhang Z, Zhang H, et al. Dietary Fiber Intake Is Associated with HbA1c Level among Prevalent Patients with Type 2 Diabetes in Pudong New Area of Shanghai, China. PLoS ONE. 2012;7(10):e46552. doi: 10.1371/journal.pone.0046552 23077514

87. Fujii H, Iwase M, Ohkuma T, Ogata-Kaizu S, Ide H, Kikuchi Y, et al. Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. Nutrition Journal. 2013;12(1):159. doi: 10.1186/1475-2891-12-159 24330576

88. Tanaka S, Yoshimura Y, Kamada C, Tanaka S, Horikawa C, Okumura R, et al. Intakes of Dietary Fiber, Vegetables, and Fruits and Incidence of Cardiovascular Disease in Japanese Patients With Type 2 Diabetes. Diabetes Care. 2013;36(12):3916–22. doi: 10.2337/dc13-0654 24170762

89. Brum J, Ramsey D, McRorie J, Bauer B, Kopecky SL. Meta-Analysis of Usefulness of Psyllium Fiber as Adjuvant Antilipid Therapy to Enhance Cholesterol Lowering Efficacy of Statins. American Journal of Cardiology. 2018;122(7):1169–74. doi: 10.1016/j.amjcard.2018.06.040 30078477

90. Mann J, De Leeuw I, Hermansen K, Karamanos B, Karlström B, Katsilambros N, et al. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutrition, Metabolism and Cardiovascular Diseases. 2004;14(6):373–94. doi: 10.1016/s0939-4753(04)80028-0 15853122

91. Mann J, Truswell S. Essentials of human nutrition: Oxford University Press; 2017.

92. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31(1):1–13. Epub 2014/10/08. doi: 10.1016/j.nut.2014.06.011 25287761.

93. Korsmo‐Haugen HK, Brurberg KG, Mann J, Aas AM. Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta‐analysis. Diabetes, Obesity and Metabolism. 2019;21(1):15–27. doi: 10.1111/dom.13499 30098129

94. Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JP, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA. 2018;319(7):667–79. doi: 10.1001/jama.2018.0245 29466592

95. Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Research & Care. 2017;5(1). doi: 10.1136/bmjdrc-2016-000354 28316796

96. American Diabetes Association. Lifestyle Management: Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019;42(Supplement 1):S46–S60. doi: 10.2337/dc19-S005 30559231

97. World Health Organization. Sugars intake for adults and children: Guideline. 2015. World Health Organization Geneva, Switzerland

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