Abstract
Objective
In this study, we aim to review the current evidence of Food is Medicine interventions
on diabetes outcomes among low-income or food-insecure individuals.
Methods
Seven databases were searched from January 1, 2000 to October 26, 2021 for full-text
articles written in English. The studies included experimental studies of any duration
and design which addressed the effect of Food is Medicine interventions on fruit and
vegetable (F&V) intake and glycated hemoglobin (A1C) levels among low-income or food-insecure
populations with prediabetes or diabetes of any age group. Only direction of effect
of interventions on F&V intake were ascertained due to high variability in outcome
measurement. A1C results were pooled using generic inverse variance with a fixed-effects
model. Heterogeneity was assessed using Cochran’s Q and quantified by I2.
Results
Sixteen studies were included. Five of the 8 studies reported a significant increase
in F&V intake. Seven of the 14 studies reported a significant decrease in A1C levels.
A meta-analysis of 5 randomized controlled trials (n=843) resulted in clinically meaningful
reductions in A1C compared with control (mean difference, −0.47%; 95% confidence interval, −0.66
to −0.29, I2=88%, p<0.0001). Half (n=8) of the studies have a high risk of bias due to missing
data, detection bias, and confounding.
Conclusions
Food is Medicine interventions are effective in increasing F&V intake and reducing
A1C levels of the target population. More randomized controlled studies are needed
to validate the results.
Résumé
Objectif
Dans la présente étude, nous avons pour objectif de passer en revue les données scientifiques
actuelles sur les effets des interventions Food is Medicine sur les résultats cliniques
liés au diabète chez les individus à faible revenu ou en insécurité alimentaire.
Méthodes
Sept bases de données ont été consultées du 1er janvier 2000 au 26 octobre 2021 pour trouver des articles complets écrits en anglais.
Les études étaient des études expérimentales de toute durée et de toute conception
qui portaient sur les effets des interventions Food is Medicine sur la consommation
de fruits et de légumes (F&L) et les concentrations de l’hémoglobine glyquée (A1c)
sur les populations prédiabétiques ou diabétiques à faible revenu ou en insécurité
alimentaire de tous les groupes d’âge. Seules les directions des effets des interventions
sur la consommation de F&L ont été déterminées en raison de la forte variabilité des
mesures des résultats. La méthode de l’inverse de la variance générique à l’aide d’un
modèle à effets fixes a permis de regrouper les résultats de l’A1c. L’hétérogénéité
a été évaluée à l’aide du test Q de Cochran et quantifiée par I2.
Résultats
Seize études ont été incluses. Cinq études sur 8 indiquaient une augmentation significative
de la consommation de F&L. Sept études sur 14 indiquaient une diminution significative
des concentrations de l’A1c. Une méta-analyse constituée de 5 essais comparatifs à
répartition aléatoire (n = 843) a permis de conclure à des réductions cliniquement
significatives de l’A1c par rapport aux témoins (différence moyenne, −0,47 %; intervalle
de confiance à 95 %, de −0,66 à −0,29, I2 = 88 %, p < 0,0001). La moitié (n = 8) des études comportent un risque élevé de biais
en raison du manque de données, de biais de détection et de confusion.
Conclusions
Les interventions Food is Medicine sont efficaces pour augmenter la consommation de
F&L et réduire les concentrations de l’A1c de la population cible. Plus d’essais comparatifs
à répartition aléatoire sont nécessaires pour valider les résultats.
Keywords
Mots clés
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Article info
Publication history
Published online: November 05, 2022
Accepted:
November 1,
2022
Received in revised form:
October 29,
2022
Received:
May 12,
2022
Identification
Copyright
© 2022 Canadian Diabetes Association.
